Cardiac Arrest Flashcards
(51 cards)
1
Q
Cardiac Arrest Standing Orders: Information:
A
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.
2
Q
Cardiac Arrest Standing Orders: Decision not to Resuscitate:
A
- 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
- No HYPOTHERMIA
3
Q
ADULT & PEDIATRIC: In general, when the scene is safe, all Cardiac Arrests should be ____.
A
- worked on scene for 20 minutes
4
Q
MICCR
A
Minimally Interrupted Cardio Cerebral Resuscitation
5
Q
Begin MICCR -
A
- 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
6
Q
Cardiac Arrest Transport Destination
A
- 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.
7
Q
Termination of Efforts of Medical Codes after Resuscitation has started.
A
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
8
Q
First step for Adult Cardiac Arrest
A
Establish Responsiveness
9
Q
Adult Cardiac Arrest
No respirations/ gasping
A
Check Pulse
10
Q
Adult Cardiac Arrest
Pulse Present
A
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
11
Q
Adult Cardiac Arrest
No Pulse
A
Begin 220 compressions
12
Q
Adult Cardiac Arrest
Airway Patent
A
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
13
Q
Adult Cardiac Arrest
V-Fib/ V-Tach
A
- 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)
14
Q
Adult Cardiac Arrest
Torsades
A
- Mag Sulfate - 2g IV/IO
* Defibrillate
15
Q
Adult Cardiac Arrest
Asystole & PEA
A
- EPI Drip
continue Epi Drip until transfer of care
16
Q
First step for Pediatric Cardiac Arrest
A
Establish Responsiveness
17
Q
Pediatric Cardiac Arrest
No respirations/ gasping
A
Check Pulse
18
Q
Pediatric Cardiac Arrest
Pulse Present
A
Insert OPA/ NPA and ventilate, 1 breath every 3 seconds, via a BVM.
- Reassess pulse every 2 minutes
19
Q
Pediatric Cardiac Arrest
No Pulse
A
Begin 220 Compressions
PIT crew HP CPR
- Briefly Pause Compression, Assess rhythm and defibrillate as needed.
20
Q
Pediatric Cardiac Arrest
Patent Airway
A
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
21
Q
Adult Cardiac Arrest
Airway FBAO
A
Attempt to remove FBAO with laryngoscope and Magil forcepts. If obstruction cannot be removed perform a cricothyrotomy
22
Q
Pediatric Cardiac Arrest
High Performance CPR
A
- 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
23
Q
Pediatric Cardiac Arrest
V-Fib/ V-Tach - Drug/ Electrical Therapy
A
- 2 J/KG first, then 4J/KG all subsequent
- EPI: (weight based dose x2) 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.
24
Q
Cardiac Arrest Standing Orders
ETCO2
A
- EtCO2 less than 10 mmHg increase effectiveness of compressions
- EtCO2 above 20 mmHg is ideal FOR RESUSCITATION
25
Cardiac Arrest Reversible Causes
| H's
* Hydrogen Ion (Acidosis)
- Ventilation
* Hyperkalemia (Renal Failure) - Ca Chloride, Sodium Bicarb, Albuterol
* Hypoglycemia - Glucose
* Hyopxia - Oxygen & Ventilate
* Hypovolemia - Fluid Bolus
* Hypothermia - Warming
26
Cardiac Arrest Reversible Causes
| T's
* Tamponade (Cardiac)
* Thrombus (coronary and pulmonary)
* Trauma
* Toxins or Tablets (OD):
- Opiates (Narcan)
- Beta Blockers (Glucagon),
- Tricyclic Antidepressants (Sodium Bicarb),
- Calcium Channel Blocker (Calcium Chloride)
* Tension Pneumothorax
- Bilateral Pleural Decompression
27
Adult Cardiac Arrest
| Hyperkalemia
* 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
28
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.
29
Adult Cardiac Arrest
| Drowning
Immediate VENTILATION
30
Adult Cardiac Arrest
| Third Trimester Cardiac Arrest
Manually displace the uterus to the left, rather than tilting the patient to the left.
31
Adult Cardiac Arrest
| Hanging
* Consider spinal motion restriction
| * Transport to closest facility
32
Adult Cardiac Arrest
| Drug Overdose
* Treat OPIOID overdoses with Narcan after cardiac arrest medications have been given.
33
Adult Cardiac Arrest
| Hypoglycemic Patients
Administer D10: 250ml IV/IO
34
Adult Cardiac Arrest
| CPR Induced Consciousness
* Defined as patients without a spontaneous heartbeat who gain consciousness while receiving CPR.
* Etomidate 10mg IV/IO. May repeat x 1 prn
35
Adult Cardiac Arrest
| Electrocution/ Lightning Strike
* Immediate Defibrillation as applicable
* Consider Spinal Motion Restriction
* Transport patient as a trauma Alert
36
Adult Cardiac Arrest
| Refractory V-Fib/ V-Tach
* Defined as persistent V-Fib/ V-Tach (with no transient interruption of V-Fib/ V-Tach) that is NOT CONVERTED by standard defibrillation (3 or more shocks)
* Initially managed by treating any applicable CORRECTABLE CAUSES (H's & T's) and appropriate antiarrythmic medications: Amiodarone: 300mg IV/IO, repeat at 150mg IV/IO after 3-5 minutes.
* If standard defibrillation attempts and 450mg of Amiodarone have failed to convert persistent V-Fib/ V-Tach, DOUBLE SEQUENTIAL DEFIBRILLATION may be utilized.
37
Double Sequential Defibrillation
* Emphasis is placed on minimizing interruptions in compressions during this procedure
* Apply an additional set of external defibrillation pads (anterior/ posterior)
* Verify both monitors/defibrillators are attached and confirm V-Fib/ V-Tach rhythm.
* 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.
* Follow defibrillation with immediate chest compressions.
38
Adult Cardiac Arrest
Post Resuscitation
Post ROSC should be managed in the order of:
* Rate (reference specific protocol)
* Rhythm (reference specific protocol)
* Blood Pressure/ICE (Goal is to maintain a SBP of 100mmHg)
* 12 - LEAD
39
Adult Cardiac Arrest
Post Resuscitation
RESQPOD
* Remove RESQPOD from the ETT or IGEL
| * Patient - Igel/ET tube - ETCO2 - RESQPOD
40
Adult Cardiac Arrest
Post Resuscitation
Next step after assessing cardiac stability and removing the RESQPOD
* Place ice pack in the Axilla and Groin
41
Adult Cardiac Arrest
Post Resuscitation
hypotensive patient
* Normal Saline - 1L bolus
| * Push Dose Epinephrine - if no response to fluid boluses
42
Adult Cardiac Arrest
Post Resuscitation
Post V-Vib/V-Tach Considerations
* Administer AMIODARONE INFUSION: (150mg into 50ml of Normal Saline, infused over 10 minutes) for patients who converted after two defibrillation and have not received an Amiodarone bolus during arrest.
* If patient converts after initial defibrillation, no anti arrhythmic should be given
* If patient does not convert after one defibrillation, give antiarrhythmic.
43
Adult Cardiac Arrest
Post Resuscitation
Post Torsades Considerations
Administer Mag Sulfate: See infusion protocol.
44
Adult Cardiac Arrest
| Transport of Cardiac Arrest
All patients in cardiac arrest will be transported to a STEMI facility if the transport time is less than 20 minutes regardless of regaining a ROSC. All other patients will be transported to the closest appropriate facility excluding free standing ED's.
45
Pediatric Cardiac Arrest
Post Resuscitation
Initial priorities following ROSC
* Maintain adequate oxygenation and ventilation
* Rate
* Rhythm
* Blood Pressure
46
Pediatric Cardiac Arrest
Post Resuscitation
Rate:
* Provide oxygenation and Ventilation if heart rate is less than 60 BPM
* Begin CPR if heart rate remains less than 60 BPM with S/S of poor perfusion (Altered Mental Status) despite oxygenation and ventilation for 60 seconds (30 seconds for a neonate)
* Push Dose Epinephrine: If after one minute of CPR the heart rate remains less than 60 BPM
47
Pediatric Cardiac Arrest
Post Resuscitation
Rhythm
Reference specific protocol
48
Pediatric Cardiac Arrest
Post Resuscitation
Blood Pressure
* Minimum Pediatric Systolic Blood Pressure Values:
* Neonates: 60 mmHg
* Infants: 70 mmHg
* Children 1-10 years old: 70 + age in years x2 mmHg
* Children greater than 10: 90 mmHg
49
Pediatric Cardiac Arrest
Post Resuscitation
Hypotension
* Fluid boluses are 20ml/kg and may be repeated 2x prn for hypotension; maximum 60ml/kg (for non trauma related hypotension).
* Assess lung sounds and blood pressure often.
50
Pediatric Cardiac Arrest Torsades
- Mag Sulfate - 40mg/kg IV/IO. Slow IVP
| - Defibrillate
51
Pediatric Cardiac Arrest 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 tool
