Special Considerations

Question 1

HYPERKALEMIA

Answer 1

• CALCIUM CHLORIDE: 1g IV/IO
• ALBUTEROL: 2.5mg via nebulizer
• SODIUM BICARBONATE: 100 mEq IV/IO

Question 2

EXCITED DELIRIUM

Answer 2

• SODIUM BICARBONATE: 100 mEq IV/IO
• COLD NORMAL SALINE (if available)

Question 3

THIRD TRIMESTER

Answer 3

• Manually displace the uterus to the left
• All third trimester patients in cardiac arrest should be treated as if they are in SECONDARY ARREST
• Transport to the closest OB hospital except trauma

Question 4

DRUG OVERDOSE

Answer 4

• Treat all drug overdoses as a SECONDARY ARREST
  Exception: Cocaine overdose
• Treat cocaine overdoses as a PRIMARY ARREST

Question 5

CPR-INDUCED CONSCIOUSNESS

Answer 5

• Defined as patients without a spontaneous heartbeat who gain consciousness while receiving CPR
• KETAMINE:
  Dilute: 200mg of Ketamine in a 50mL bag of NORMAL SALINE or D5W Administer IV/IO utilizing a 60 gtt set, run wide open

Question 6

REFRACTORY V-FIB/V-TACH

Answer 6

Defined as persistent V-Fib/V-Tach with no transient interruption of V-Fib/V-Tach after 5 defibrillations. If ALL 3 of the below treatments have failed to convert the refractory V-Fib/V-Tach.

Question 7

REFRACTORY V-FIB/V-TACH TREATMENT

Answer 7

• DOUBLE SEQUENTIAL DEFIBRILLATION:
• Apply an additional set of external defibrillation pads anterior/lateral OR anterior/posterior depending on where the initial pads were placed
• Verify both monitors/defibrillators are attached and confirm V-Fib/V-Tach rhythm on both monitors
• Charge both monitors to the maximum energy setting and ensure all team members are clear of the patient
• Defibrillate by pressing both shock buttons as synchronously as possible
• Repeat every 2 minutes until termination of Refractory V-Fib/V-Tach
• ESMOLOL: 40mg IV/IO over 1 minute
• ESMOLOL INFUSION (IF REFRACTORY V-FIB/V-TACH IS STILL PRESENT):
  Dilute: 60mg of ESMOLOL in a 50mL bag of NORMAL SALINE or D5W
  Administer over 10 minutes IV/IO by utilizing a 10 gtt set delivering 1 gtt/sec

Question 8

DROWNING

Answer 8

• Treat as a SECONDARY ARREST
• No drowning victim is to be pronounced dead at the scene if the possibility of hypothermia exists
• Remove patient’s wet clothes, dry, and cover with blankets

Question 9

HANGING

Answer 9

• Treat as a SECONDARY ARREST
• Consider spinal motion restriction
• Transport to closest facility

Question 10

CYANIDE EXPOSURE

Answer 10

• Any firefighter who suffers cardiac arrest during or within 6 hours after a fire incident shall be treated for a cyanide exposure

Question 11

ELECTROCUTION (ALTERNATING CURRENT)

Answer 11

• Treat as a PRIMARY ARREST
• Immediate DEFIBRILLATION as applicable
• Consider spinal motion restriction
• Transport patient as a Trauma Alert