Cardiac Arrest Update (12/18) Flashcards
(21 cards)
Asystole algorithm
- CPR
- Epi every 4 min up to 3 doses
- Empiric shock after 2-3 rounds CPR if no QRS noted
- Consider H&T’s
- No organized rhythm after 30 mins, may terminate as long as all termination criteria is met.
PEA algorithm
- CPR
- Epi every 4 min up to 3 doses
- Consider H&T’s
- ECMO candidate? If no pulse with organized rhythm after 10 minutes, call OLMC at UMC.
- NOT ECMO Candidate? If no pulse with organized rhythm after 40 min, may terminate as long as all termination criteria is met.
Treatment for reversible causes of cardiac arrest?
Dextrose if hypoglycemic.
Bicarb if hyperkalemia strongly suspected.
Fluids if volume depleted.
V-FIB / V-TACH algorithm
- CPR
- Defibrillation (No longer than 2 minutes in a shockable rhythm without defibrillation)
* Shock as indicated. More frequently than 2 minutes is preferred - Epi every 4 min up to 3 doses
- Recurrent or refractory VF algorithm as needed (Ami 300mg loading, 150mg maintenance dose)
- Consider H&T’s
- ECMO Candidate? 15 minutes resuscitation on scene then transport to UMC
- Not an ECMO candidate? 40 minutes on scene resuscitation minimum.
Refractory or Recurrent V-Fib/V-TACH algorithm
- Refractory: Fails to terminate despite 3 shocks
If refractory change defib pad vector. - Recurrent - Withhold next epinephrine dose.
- Antiarrythmics - Amio 300mg IVP / 150mg IVP 5 min later if needed.
30:2 with BLS airway…
is associated with higher survival rate in large randomized trial.
No asynchronous breaths with BLS airways.
ALS Interventions for Cardiac Arrest
- IV preferred / IO as backup
- Epinephrine
Up to 3 doses.
If Epi dependent, start drip. - Supraglottic airway and elevate head ~30 degrees.
- Intubate after 20 minutes of resuscitation efforts or if ROSC is achieved.
When placing a supraglottic airway in cardiac arrest patients…
you should next elevate the head ~30 degrees.
Continue 30:2 ventilation rate.
Changes in intubation protocols include…
- 20 minutes of resuscitation prior to intubation
or
ROSC is achieved. - If waveform capnography is not working - must replace with supraglottic airway.
Field Transport for ECMO Criteria
- Presumed cardiac cause
- non-traumatic, not suicide related, not an overdose, etc. - Initial shockable rhythm or PEA
- Witnessed arrest
- CPR within 10 minutes of collapse.
- Remains pulseless after 15 min of scene efforts.
Field Termination Criteria
All of the following must be present:
- Arrest not witnessed by EMS
- No shocks delivered for VF
- No ROSC at any time
- Patient does not have a pulse.
Pulseless Determination Criteria
VF/VT: Continue resuscitation and transport.
Asystole: Terminate
Organized rhythm >20 bpm… ETCO2 >20… perform carotid pulse check and look for spontaneous pulsations on SpO2… Transport.
Organized rhythm <20... narrow or wide? Narrow... is ETCO2 >20.... Yes - Continue No- Terminate Wide <20 bpm - terminate.
Does ETCO2 maintain or fall during 20 seconds CPR pause with regular ventilations?
Maintains - pulse is probably present…. transport.
Falls… Terminate
BVM only if…
patient is < 14 years old.
Limit scene time for resuscitation when…
ECMO candidate, pregnancy, hypothermia.
Protocol for antiarrythmic treatments due to recurrent or refractory VF
> 3 shocks prior to antiarrythmics
Simple field termination…
- Not witnessed by EMS, No shock delivered for VF/VT, No ROSC
- Contact UMC to clear termination by OLMC
- Appropriate duration of resuscitation…
Asystole: 30 minutes
Otherwise: 40 minutes
No C-collars during cardiac arrest because…
they increase ICP.
Leave enough slack when securing thomas tube holder…
to slide a finger under the strap.
Lucas device placement criteria
- Limited personnel for manual CPR
- Prolonged on scene resuscitation attempts
- Transport with ongoing CPR.
Downsides to LUCAS
- Pause associated with placement
- Decreased shock and pulse check frequency
- Placement too high on chest leading to poor/no blood flow.
LUCAS piston should be placed..
with the core of the piston over the lowest part of the sternum
