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Sara's - Medical Directives > Medical + Trauma Cardiac Arrest > Flashcards

Medical + Trauma Cardiac Arrest Flashcards

1
Q

Medical Cardiac Arrest Medical Directive

What are the INDICATIONS?

How do I establish a non-traumatic situation? Observations, Questions?

What does refractory mean?

A

Has to be a non-trauamatic cariac arrest

Observe the pertinant negatives, the MOI, and make a clinical judgment

Keeps falling back into it

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2
Q

Medical Cardiac Arrest Medical Directive

In what settings should you consider very early transport AFTER a minimum of 1 analysis once an egress plan is organized?

Pregnancy situation, what’s considered 20 weeks gestation + action plan?

What do you do for patients in refractory VF or pulseless VT?

A

pregnancy presumed to be GREATER/EQUAL to 20 weeks gestation

hypothermia

airway obstruction

non-opioid drug overdose/toxicology

OR

other known reversible cause of arrest not addressed

Fundus above umbilicus and ensure manual displacement of uterus to left

transport after the 3rd consecutive shock
switch the pads from regular position to posterior and anterior

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3
Q

Medical Cardiac Arrest Medical Directive

What are the CONDITIONS for CPR?

What are the CONTRAINDICATIONS for CPR?

A

Must be performed in 2min intervals

An altered LOA

Obviously dead as per BLS PCS
OR
Meet conditions of DNR standard

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4
Q

Medical Cardiac Arrest Medical Directive

What are the CONDITIONS for AED Defibrillation?

What are the CONTRAINDICATIONS for AED Defibrillation?

A

Pt has to be GREATER/EQUAL to 24h old

An altered LOA

It’s indicated by the defib

If manual defibrillation isn’t in use

Non-shockable rhythm

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5
Q

Medical Cardiac Arrest Medical Directive

What are the CONDITIONS for Manual Defibrillation?

What are the CONTRAINDICATIONS for Manual Defibrillation?

A

pt is GREATER/EQUAL to 24h old

pt is altered (LOA)

pt is in TF of pulseless VT

Rhythms other than VF or pulseless VT

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6
Q

Medical Cardiac Arrest Medical Directive

What are the CONDITIONS for epinephrine?

How many doses of epi would you give in a VSA?

What are the CONTRAINDICATIONS for epinephrine?

A

Pt has to be GREATER/EQUAL to 24h old

Have an altered LOA

Have anaphylaxis suspected as a causative event

1

Allergy or sensitivity

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7
Q

Medical Cardiac Arrest Medical Directive

What are the CONDITIONS for a medical TOR?

What are the CONTRAINDICATIONS for a medical TOR?

A

Pt has to be GREATER/EQUAL to 16y old

Altered LOA

Arrest not witnessed by paramedic
AND
No ROSC after 20 minutes of resuscitation
AND
No defibrillation delivered

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

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8
Q

Medical Cardiac Arrest Medical Directive

What do you do if the patch fails?

Mandatory Provincial Patch Point

What sould you consider doing in terms of patching?

A

Transport to the closest appropriate hospital following ROSC or 20 minutes of resuscitation without ROSC (do this if the TOR doesn’t apply either)

Patch early after the 4th analysis to consider TOR
For PCPs the patch has to follow 20min of resuscitation

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9
Q

Medical Cardiac Arrest Medical Directive

What is the TREATMENT plan for Manual Defibrillation for a patient GREATER/EQUAL to 24h old but LESS then 8y old?

What is the TREATMENT plan for Manual Defibrillation for a patient GREATER/EQUAL then 8y old?

A

Dose - 1 defibrillation

Initial dose - 2J/kg

Subsequent and max dose(s) - 4 J/kg

Dosing interval - 2 min

Max # of doses - reasonably unlimited

Dose - 1 defibrillation

Initial dose - As per BH/ manufacturer

Subsequent and max dose(s) - As per BH/ manufacturer

Dosing interval - 2 min

Max # of doses - reasonably unlimited

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10
Q

Medical Cardiac Arrest Medical Directive

What is the TREATMENT plan for an AED for a patient GREATER/EQUAL to 24h old but LESS then 8y old?

What is the TREATMENT plan for an AED for a patient GREATER/EQUAL then 8y old?

A

Dose - 1 defibrillation

Max.single Dose - As per BH/manufacturer

Dosing interval - 2 min

Max # of doses - reasonably unlimited

Dose - 1 defibrillation

Max.single Dose - As per BH/manufacturer

Dosing interval - 2 min

Max # of doses - reasonably unlimited

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11
Q

Medical Cardiac Arrest Medical Directive

What is the TREATMENT plan, CONCENTRATION, and ROUTE for epinephrine

Remember the condition?

what about the dose?

A

Route - IM

Concentration - 1:1000

Dose - 0.01mg/kg

Max.Single Dose - 0.5mg

Dosing interval - no interval

Max # of doses - 1

ONLY if anaphylaxis is the causative event

it can be rounded to the nearest 0.05mg

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12
Q

Medical Cardiac Arrest Medical Directive

What are top 2 CLINICAL CONSIDERATIONS?

A

Consider RBH advanced airway strategy -SGA- where more than OPA/NPA and BVM is required

There is no clear role for routine administration of naloxone in confirmed cardiac arrest

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13
Q

Medical Cardiac Arrest Medical Directive

What are the extenuating circumstances? (does’nt meet TOR but should)

What are the impeeding factors for a TOR? (stuff the doctor is gonna be like mmmmm I don’t know)

A
  • extenuating egress
  • limitations
  • prolonged transport
  • caregiver wishes
  • existence of DNR confirmation form
  • underlying end stage progressive illness

The BHP might NOT authorize TOR even though the patient meets TOR rule:
- location of the patients
- EtCO2
- age
- bystander witnessed
- bystander CPR
- transportation time
- unusual cause of cardiac arrest such as
electrocution, hanging, and toxicology

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14
Q

Trauma Cardiac Arrest Medical Directive

What are the INDICATIONS?

How do I establish a non-traumatic situation? Observations, Questions?

A

Cardiac Arrest secondary to severe blunt or penetrating trauma

Make a clinical observation, analysis, and judgment of the overall scene

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15
Q

Trauma Cardiac Arrest Medical Directive

What are the CONDITIONS for CPR?

What are the CONTRAINDICATIONS for CPR?

A

An altered LOA

Must be performed in 2min intervals

Obviously dead as per BLS PCS

Meet conditions of Do Not Resuscitation (DNR) Standard

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16
Q

Trauma Cardiac Arrest Medical Directive

What are the CONDITIONS for AED Defibrillation?

What are the CONTRAINDICATIONS for AED Defibrillation?

A

Pt has to be GREATER/EQUAL to 24h old

An altered LOA

It’s indicated by the defib

If manual defibrillation isn’t in use

Non-shockable rhythm

17
Q

Trauma Cardiac Arrest Medical Directive

What are the CONDITIONS for Manual Defibrillation?

What are the CONTRAINDICATIONS for Manual Defibrillation?

A

GREATER/EQUAL to 24h old

an altered LOA

VF or pulseless VT

Rhythm other than VF or pulseless VT

18
Q

Trauma Cardiac Arrest Medical Directive

What are the conditions of a TOR?

A

pt has to be GREATER/EQUAL to 16y old

has to be altered

no palpable pulses
AND
no defibrillation delivered
AND
rhythm asystole
AND
No signs of life since fully extricated OR
their are/were signs of life with the closest ED GREATER/EQUAL to 30min away OR
rhythm PEA with the closest ED GREATER/EQUAL to 30min

19
Q

Trauma Cardiac Arrest Medical Directive

What are the CONTRAINDICATIONS for TOR?

What does organized electrical activity on ECG mean/look like?

What are the 4 signs of life?

A

pt is LESS then 16y old

defibrillation deliveredelivered

signs of life since fully extricated

rhythm PEA and closest ED is LESS then 30min away

the pt has a penetrating trauma to the torso or head/neck and the LTH is LESS then 30min away

PEA - electrical activity is there but not siffcient enough to contract

respirstory efforts

reactive pupils

any spontaneous movement

organize electrical activity on ECG

20
Q

Trauma Cardiac Arrest Medical Directive

What do you do if the patch fails or the TOR doesn’t apply?

Mandatory Provincial Patch Point

A

Transport to the closest appropriate receiving facility following the 1st analysis/defibrillation.

21
Q

Trauma Cardiac Arrest Medical Directive

What is the TREATMENT plan for Manual Defibrillation for a patient GREATER/EQUAL to 24h old but LESS then 8y old?

What is the TREATMENT plan for Manual Defibrillation for a patient GREATER/EQUAL then 8y old?

A

Dose - 1 defibrillation

Initial dose - 2J/kg

Dosing interval - no interval

Max # of doses - 1

Dose - 1 defibrillation

Initial dose - As per BH/ manufacturer

Dosing interval - no interval

Max # of doses - 1

22
Q

Trauma Cardiac Arrest Medical Directive

What is the TREATMENT plan for an AED for a patient GREATER/EQUAL to 24h old but LESS then 8y old?

With or without the pediatric cable - what is that?

What is the TREATMENT plan for an AED for a patient GREATER/EQUAL 8y old?

A

Dose - 1 defibrillation

Max.single Dose - As per BH/manufacturer

Dosing interval - no interval

Max # of doses - 1

same either way, it’s Pediatric defibrillation cables

Dose - 1 defibrillation

Max.single Dose - As per BH/manufacturer

Dosing interval - no interval

Max # of doses - 1

23
Q

Trauma Cardiac Arrest Medical Directive

How and what do you do to determine if it’s a traumatic situation?

Should I consider a fluid bolus for a trauma cardiac arrest patient?

A

If no obvious external signs of significant blunt trauma, consider medical cardiac
arrest and treat accordingly

An intravenous fluid bolus may be considered, where it does not delay transport and should not be prioritized over the management of other reversible pathology. This assists with potential reversible causes.

24
Q

Cardiac Arrest Standards - clinical considerations - things to remember

What should you remeber about Rhythm interpretation/analysis?

What about pre-arrival interventions? Consider?

How do you follow the energy settings?

A

Should be performed immediatly

Should have subsequent interpretations/analyses occuring at 2min intervals

Keep with good quality CPR

DON’T count them, complete a full 20min of resus and consider patching

follow specific manufacturer guidelines that are supported by each respective RBH program

25
Q

Cardiac Arrest Standards- clinical considerations - things to remember

What tretment is preferred?

What about CPR and charging?

Can the ambulance be moving or stopped when using a semi-automated rhythm analysis en-route?

What if you’re using a manual interpretation?

A

Manual defibrillation

continue with compressions during the charge cycle

It MUST be stopped to minimize artifact and the risk of an inaccurate rhythm interprestation/analysis.

It SHOULD be stopped…

26
Q

Cardiac Arrest Standards - supraglottic airway

Once the supraglottic airway is placed you should continue with compression and provide vetilations asynchronously at a rate of ? for adults?

For children and infants?

A

10 breaths/min (1 every 6sec)

20 breaths/min (1 every 3sec)

27
Q

Cardiac Arrest Standards - ROSC

What should you do if there’s a ROSC while en-route and there’s a re-arrest but you’re using a semi-automated defibrillator?

What do you if you think they would benifit from further interpretation?

A

Pull over

Initiate 1 immediate rhythm interpretation/analysis

Treat rhythm appropriately

AND

Continue with transportation to the receiving facility with NO FURTHER STOPS.

Patch to the BHP

28
Q

Cardiac Arrest Standards- clinical considerations - things to remember

What do you do for sudden cardiac arrests that occur on scene or en-route?

What are known reversible causes of a cardiac arrest?

A

Use full medical cardiac arrest medical directive - i.e. 20min rhythm analyses

Hypovolemia

Hydrogen ion (acidosis)

Hyper/hypokalemia

Toxins

Tension Pneumothorax

Thrombosis (pulmonary and coronary)

Tamponade (cardiac)

29
Q

Cardiac Arrest Standards- clinical considerations - things to remember

Is BGL important?

Remember to ? when analysis reveals a non-shockable rhythm -what’re they

What are commotio cordis (chest impact) + hangings treated as?

A

NO it serves no clinical value

Check for a pulse (the rhythms mentioned are PEA and Asystole)

Medical Cardiac arrests

30
Q

Cardiac Arrest Standards- clinical considerations - things to remember

Anaphylactic Cardiac Arrest is treated as?

Electrocution situation and defibrillation concerns?

Asthmatic Cardiac Arrest treat as?

A

A single dose of IM epinephrine 1:1,000 is indicated if you believe it’s directly related to the anaphylactic reaction and treat as medical arrest - DO NOT delay the transport

Consider this ‘unusual circumstances’ for transport

If there’s significant trauma then treat as such

Treat as medical, responds well usually

Medical cardiac arrest knowing that salbutamol is difficult to deliver effectively and so you should focus on ventilation and oxygenation

Sara's - Medical Directives (16 decks)

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