Return of Spontaneous Circulation (ROSC) Medical Directive

Question 1

Return of Spontaneous Circulation (ROSC) Medical Directive

Answer 1

A Primary Care Paramedic may provide the treatment prescribed in this Medical DIrective if authorized.

Question 2

Indications

Answer 2

Patient with return of spontaneous circulation (ROSC) after the resuscitation was initiated.

Question 3

Conditions - 0.9% NaCl Fluid Bolus

Answer 3

Age: ≥2 years
LOA: N/A
HR: N/A
RR: N/A
SBP: Hypotension
Other: Chest auscultation is clear

Question 4

Contraindications - 0.9% NaCl Fluid Bolus

Answer 4

Fluid overload

Question 5

Treatment

Answer 5

Consider optimizing ventilation and oxygenation
Consider 0.9% NaCl fluid bolus (if available and authorized)
Consider 12-lead ECG acquisition and interpretation

Question 6

Consider optimizing ventilation and oxygenation

Answer 6

Titrate oxyegenation 94-98%

Avoid hyperventilation and target ETCO2 to 30-40 mmHg with continous waveform capnography (if available)

Question 7

Consider 0.9% NaCl fluid bolus (if available and authorized)

Answer 7

Age ≥2 years to <12 years
Route: IV
Infusion: 10 ml/kg
Infusion interval: Immediate
Reassess every: 100 ml
Max. volume: 1000 ml
Age ≥12 years
Route: IV
Infusion: 10 ml/kg
Infusion interval: Immediate
Reassess every: 250 ml
Max. volume: 1000 ml

Question 8

Clinical Considerations

Answer 8

Consider initiating transport in parallel with the above treatment.
IV fluid bolus applies only to PCPs authorized for PCP Autonomous IV.