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Flashcards in Cardiac Arrest Deck (49)
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Cardiac Arrest Standing Orders: Information:

There is no scientific basis for starting the resuscitation process on a patient in asystole who has succumbed to the dying process of a terminal illness. Consideration should be given to NOT starting resuscitation efforts in these cases.


Cardiac Arrest Standing Orders: Decision not to Resuscitate:

* Pt must be in asystole and apneic
* If one of the following are present
- Lividity
- Rigor Mortis
- Tissue decomposition
- A Valid DNR is in place (yellow paper)
- Injury incompatible with life

* If ALL of the following are present
- Known downtime > 20 min with no CPR
- Asystole
- Pupils Fixed and Dilated
- Apneic


ADULT & PEDIATRIC: In general, when the scene is safe, all Cardiac Arrests should be ____.

* worked on scene for 20 minutes



Minimally Interrupted Cardio Cerebral Resuscitation


Begin MICCR -

* Emphasis is placed on minimizing interruptions in compressions to no more than 5 seconds
* Defibrillations: 200J for adult and 2J/kg initially for pediatrics then subsequent shocks at 4J/kg
* Perform all assignments in Pit Crew fashion and make all efforts to obtain a ROSC prior to leaving the scene.
* Once available, apply the monitor/ defibrillator with minimal interruptions to chest compressions and set to continuous compressions.
* The ResQPOD shall be used on all pulseless adult patients without chest trauma and all pediatric patients > 1 year.
* Patient Igel-ETCO2-RESQPOD


Cardiac Arrest Transport Destination

* All cardiac arrest patients will be transported to the closest approved STEMI Facility if transport time is less than 20 minutes
* Pediatric patients who have regained a ROSC shall be transported to a comprehensive pediatric emergency department. Pulseless pediatric patients shall be transported to closest appropriate emergency department (excluding Free Standing ED's)
* All Witnessed Cardiac Arrest Patients Must be Transported.


Termination of Efforts of Medical Codes after Resuscitation has started.

Consider terminating efforts when an "officer in charge" determines appropriate and:
* Persistent Asystole has been documented for 15 minutes
* ETCO2 of less than 10mmHg
* Absence of hypothermia
* Normal Saline 500ml Must be administered
* All ALS interventions have been completed
* Reversible causes have been addressed (H's and T's)
* Social support group is in place for the family if needed


First step for Adult Cardiac Arrest

Establish Responsiveness


Adult Cardiac Arrest
No respirations/ gasping

Check Pulse


Adult Cardiac Arrest
Pulse Present

Inset OPA/ NPA and ventilate
* 1 breath every 6 seconds, via a BVM
If patient requires ventilatory support for more than 2 minutes the patient should receive an Advance Airway.
* Reassess pulse every 2 minutes


Adult Cardiac Arrest
No Pulse

Begin 220 compressions


Adult Cardiac Arrest
Airway Patent

High Performance CPR
* Ventilate 2x via BVM
* Place an IGEL and RESQPOD
* Perform cycles of 220 compressions in two minutes, 5 seconds pause for rhythm check and defibrillate
* Asynchronous breaths with compressions
* 1 breath every 10 seconds
* PIT CREW and apply auto pulse
* Left Humeral IO needle


Adult Cardiac Arrest
V-Fib/ V-Tach

* Defib: 200J
* EPI Drip
(Continue Epi Drip until transfer of care)
* Amiodarone
- 1st Dose - 300mg IV/IO
-2nd Dose - 150mg IV/IO
(OK to substitute Lidocaine when Amiodarone is not available.
- Lidocaine 100mg IV/IO push. Repeat once after 5 minutes if no effect)


Adult Cardiac Arrest

* Mag Sulfate - 2g IV/IO
* Defibrillate


Adult Cardiac Arrest
Asystole & PEA

* EPI Drip
(continue Epi Drip until transfer of care)


First step for Pediatric Cardiac Arrest

Establish Responsiveness


Pediatric Cardiac Arrest
No respirations/ gasping

Check Pulse


Pediatric Cardiac Arrest
Pulse Present

Insert OPA/ NPA and ventilate, 1 breath every 3 seconds, via a BVM.
- Reassess pulse every 2 minutes


Pediatric Cardiac Arrest
No Pulse

Begin 220 Compressions
- Briefly Pause Compression, Assess rhythm and defibrillate as needed.


Pediatric Cardiac Arrest
Patent Airway

Ventilate 2x via BVM
* Insert an IGEL and ventilate at a rate of 1 breath every 6 seconds, asynchronized with cycles of 220 compressions
* Place RESQPOD for age > 1 year
* Patient - IGEL - ETCO2 - RESQPOD


Adult Cardiac Arrest
Airway FBAO

Attempt to remove FBAO with laryngoscope and Magil forcepts. If obstruction cannot be removed perform a cricothyrotomy


Pediatric Cardiac Arrest
High Performance CPR

* 2 BVM Then Place an IGEL
* Perform cycles of 220 compressions in two minutes, 5 second pause for rhythm check and defibrillate
* Asynchronous breaths with compressions
* 1 breath every 6 seconds
* PIT Crew
* IO needle
- Humeral > 10 yoa
- Femoral < 10 yoa


Pediatric Cardiac Arrest
V-Fib/ V-Tach - Drug/ Electrical Therapy

* 2 J/KG first, then 4J/KG all subsequent
* EPI: (weight based dose *2) in 100ml bag over 16 min (use 1:10,000 for dosing according to Handtevy or Med tool)
* Amiodarone 5mg/kg every 5 min. Max single dose 300mg. May repeat 1x.
* Torsades
- Mag Sulfate - 40mg/kg IV/IO. Slow IVP
- Defibrillate
* Asystole & PEA
- EPI: (weight based dose *2) in 100 ml bag over 16 min ( use 1:10,000 for dosing according to Handtevy or Med


Cardiac Arrest Standing Orders

* EtCO2 less than 10 mmHg increase effectiveness of compressions
* EtCO2 above 20 mmHg is ideal FOR RESUSCITATION


Cardiac Arrest Reversible Causes

* Hydrogen Ion (Acidosis) - Ventilation
* Hyperkalemia (Renal Failure) - Ca Chloride, Sodium Bicarb, Albuterol
* Hypoglycemia - Glucose
* Hyopxia - Oxygen & Ventilate
* Hypovolemia - Fluid Bolus
* Hypothermia - Warming


Cardiac Arrest Reversible Causes

* Tamponade (Cardiac)
* Thrombus (coronary and pulmonary)
* Trauma
* Toxins or Tablets (OD): - Opiates, - Beta Blockers (Glucagon), - Tricyclic Antidepressants (Sodium Bicarb), Calcium Channel Blocker (Calcium Chloride)
* Tension Pneumothorax - Bilateral Pleural Decompression


Adult Cardiac Arrest

* Calcium Chloride: 1 gram, slow IV/IO over 2 minutes
* Once intubated, Albuterol: 10mg via nebulizer, 4 x 2.5mg continuous treatments
* Sodium Bicarbonate: 50 mEq IV/IO, administered slow over 2 minutes


Adult Cardiac Arrest
Excited Delirium

* Sodium Bicarbonate: 50 mEq IV/IO, amp administered slow over 2 minutes.
* Cold Normal Saline (if available): 30ml/kg IV/IO. Maximum of 1L. Assess lung sounds every 500ml.


Adult Cardiac Arrest



Adult Cardiac Arrest
Third Trimester Cardiac Arrest

Manually displace the uterus to the left, rather than tilting the patient to the left.