Medical Cardiac Arrest Medical Directive

Question 1

Medical Cardiac Arrest MD

What are the indications for the medical cardiac arrest md?

Answer 1

Non-traumatic cardiac arrest.

Question 2

Medical Cardiac Arrest MD

What are the conditions for CPR?

Answer 2

LOA: Altered
Other: Performed in 2 minute intervals.

Question 3

Medical Cardiac Arrest MD

What are the conditions for Manual Defibrillation?

Answer 3

Age: ≥24 hours
LOA: Altered
Other: VF OR pulseless VT

Question 4

Medical Cardiac Arrest MD

What are the conditions for AED or SAED Defibrillation?

Answer 4

Age: ≥24 hours
LOA: Altered
Other: Defibrillation indicated. If not using manual defibrillation.

Question 5

Medical Cardiac Arrest MD

What are the conditions for epinephrine administration?

Answer 5

Age: ≥24 hours
LOA: Altered
Other: Anaphylaxis suspected as causative event.

Question 6

Medical Cardiac Arrest MD

What are the conditions for a medical TOR?

Answer 6

Age: ≥16 years
LOA: Altered
Other: Arrest not witnessed by paramedic
AND
No ROSC 20 minutes of resuscitation
AND
No defibrillation delivered.

Question 7

Medical Cardiac Arrest MD

What are the contraindications to CPR?

Answer 7

Obviously dead as per BLS PCS
Meet conditions of the BLS PCS Do Not Resuscitate (DNR) Standard

Question 8

Medical Cardiac Arrest MD

What are the contraindications to Manual Defibrillation?

Answer 8

Rhythms other than VF or pulseless VT.

Question 9

Medical Cardiac Arrest MD

What are the contraindications to AED or SAED Defibrillation?

Answer 9

Non-shockable rhythm.

Question 10

Medical Cardiac Arrest MD

What are the contraindications to epinephrine administration?

Answer 10

Allergy or sensitivity to epinephrine.

Question 11

Medical Cardiac Arrest MD

What are the contraindications to a Medical TOR?

Answer 11

Known reversible cause of the arrest unable to be addressed.
Pregnancy presumed to be ≥20 weeks gestation.
Suspected hypothermia.
Airway obstruction.
Non-opioid drug overdose/toxicology.

Question 12

Medical Cardiac Arrest MD

What is the dosing for manual defibrillation ≥24 hours to <8 years?

Answer 12

Initial dose of 2 J/kg, subsequent doses 4 J/kg. Dosing interval 2 min, max # of doses n/a.

Question 13

Medical Cardiac Arrest MD

What is the dosing for manual defibrillation ≥8 years?

Answer 13

As per RBHP/manufacturer.
Dosing interval 2 min, max # of doses n/a.

Question 14

Medical Cardiac Arrest MD

What is the dosing for epinephrine?

Answer 14

Route: IM
Concentration: 1 mg/ml - 1:1000
Dose: 0.01 mg/kg
Max single dose: 0.5 mg
Dosing interval: n/a
Max # of doses: 1
Epi dose may be rounded to the nearest 0.05 mg.

Question 15

Medical Cardiac Arrest MD

When do we normally transport, if patch for TOR fails, or TOR doesn’t apply?

Answer 15

Transport to the closest appropriate hospital following ROSC or 20 minutes of resuscitation without ROSC.

Question 16

Medical Cardiac Arrest MD

When would we patch early (following the 4th analysis) to consider a TOR?

Answer 16

If there are extenuating circumstances surrounding egress, prolonged transport, or significant clinical limitations where the paramedic considers ongoing resuscitation to be futile.

Question 17

Medical Cardiac Arrest MD

Can the BHP deny or approve a Medical TOR even if the patient meets or does not meet the criteria for a TOR?

Answer 17

Yes.

Question 18

Medical Cardiac Arrest MD

When should very early transport (after a minimum of one analysis and defibrillation if indicated) once an egress plan is organized be considered?

Answer 18

1. pregnancy presumed to be ≥20 weeks gestation (fundus above umbilicus, ensure manual displacement of the uterus to the left);
2. hypothermia;
3. airway obstruction;
4. non-opioid drug overdose/toxicology, or;
5. other known reversible cause of arrest not addressed.

Question 19

Medical Cardiac Arrest MD

When should transport of refractory VF or pulseless VT patients take place?

Answer 19

After the third consecutive shock.

Question 20

Medical Cardiac Arrest MD

How is refractory VF or pulseless VT defined in the medical cardiac arrest MD?

Answer 20

Persistent VF or pulseless VT after 3 consecutive shocks.