Cardiac Arrest States – Adult
Standing Orders
1.
If cardiac arrest occurs in the presence of the ambulance crew, assess the
patient’s cardiac rhythm and defibrillate if V-Fib or Pulseless V-Tach.
2.
Upon arrival of the ambulance crew and patient is found in cardiac arrest:
A. Institute or continue CPR
i)
Provide continuous compressions 100/min without interruptions for
ventilations.
ii)
Provide breaths 8-10/min. Do not over ventilate.
iii)
No 30:2 compression/ventilation ratio
iv)
Insure the following:
Clinician 1
Clinician 2
Oral Airway
BVM
ResQPOD
ResQSTRAP
Gain vascular access rapidly:
IV/IO
Prepare medications
AED in Place
1.
2.
3.
Leave AED in place
Apply Lucas device unless contraindicated, minimizing interruptions in CPR during
application.
Apply LifePak 12/15, charge to 200J. Once charge is complete, evaluate rhythm
A.
If rhythm is shockable, defibrillate and proceed to appropriate protocol
B.
If rhythm is non-shockable, dump charge, check pulse and proceed to
appropriate
protocol
NO AED in Place
1.
2.
3.
Apply LifePak 12/15, charge to 200J. Once charge is complete, evaluate rhythm.
A.
If rhythm is shockable, defibrillate and proceed to appropriate protocol.
B.
If rhythm is non-shockable, dump charge, check pulse and proceed to
appropriate
protocol.
Apply Lucas device unless contraindicated, minimizing interruptions in CPR during
application.
Start your two minute timer. Consider using the timer found in the Cardiac Power Tool
in Field Bridge.
Cardiac Arrest States – Adult
V-FIB and Pulseless V-TACH
Standing Orders
1.
Charge LifePak 12/15 prior to assessing pulse. Confirm Pulseless VT/VF rhythm;
resume Lucas (if applied). Defibrillate, if necessary at 200J.
2.
Administer Epinephrine, 1 mg (1:10,000) IV/IO.
3.
Charge LifePak 12/15 prior to assessing pulse. Confirm Pulseless VT/VF rhythm;
resume Lucas (if applied). Defibrillate, if necessary at 300J.
4.
Administer Amiodarone, 300 mg IV/IO.
5.
Charge LifePak 12/15 prior to assessing pulse. Confirm Pulseless VT/VF rhythm;
resume Lucas (if applied). Defibrillate, if necessary at 360J.
6.
Administer Vasopressin, 40 units IV/IO.
7.
Charge LifePak 12/15 prior to assessing pulse. Confirm Pulseless VT/VF rhythm;
resume Lucas (if applied). Defibrillate, if necessary at 360J.
8.
Administer Amiodarone 150 mg IV/IO.
9.
Charge LifePak 12/15 prior to assessing pulse. Confirm Pulseless VT/VF rhythm;
resume Lucas (if applied). Defibrillate, if necessary at 360J.
Place Endotracheal Tube without interruption of compressions. If unable to place ET
tube, consider King LTS-D Device or continue with oral airway/BVM. Confirm airway
placement and monitor ETC02. Utilize advanced airway management when
appropriate.
Continue charging LifePak 12/15 prior to assessing for shockable rhythm every two
minutes for a total of 30 minutes.
Contact Medical Control for further orders.
After Obtaining Verbal Orders:
1.
Consider additional anti-arrhythmic.
2.
Consider Magnesium Sulfate 2 Gm IV/IO for Torsades de Pointes.
3.
If no response, consider termination of resuscitative efforts after 30 minutes.
Recommended Provider Impression: Cardiac Arrest
Cardiac Arrest States – Adult
Asystole and PEA
Standing Orders
1.
Review the most frequent causes for Asystole/PEA, treat according to protocols.
2.
Administer Epinephrine 1 mg (1:10,000) IV/IO.
3.
Administer Vasopressin 40 units IV/IO.
Place Endotracheal Tube without interruption of compressions. If unable to place ET
tube, consider King LTS-D Device or continue with oral airway/BVM. Confirm airway
placement and monitor ETC02. Utilize advanced airway management when
appropriate.
Continue charging LifePak 12/15 prior to assessing for shockable rhythm every two
minutes for a total of 30 minutes.
Contact Medical Control for further orders.
After Obtaining Verbal Orders:
1.
Consider verbal orders for:
A.
Hyperkalemia - Calcium Chloride 1 Gm IV/IO and
Sodium Bicarbonate 50 mEq IV/IO.
B. Tension Pneumothorax - needle decompression.
C. Drug overdose - drug specific.
2.
Consider termination of efforts if no response from interventions after 30
minutes.
Special Situations/Considerations in Cardiac Arrest - Adult
Standing Orders
1.
For renal patients in cardiac arrest contact Medical Control for treatment of
hyperkalemia.
After Obtaining Verbal Orders:
1.
Consider for treatment of Hyperkalemia.
A.
Calcium Chloride 1 Gm IV/IO.
B.
Sodium Bicarbonate 50mEq IV/IO.
Recommended Provider Impression: Cardiac Arrest
Cardiac Arrest States – Adult
Return of Spontaneous Circulation and Cooling
Standing Orders
1.
Remove ResQPOD.
2.
Obtain a 12-lead EKG.
3.
Begin cardiac cooling measures.
A. Inclusion Criteria
i)
Patient must be 18 years of age or older.
ii)
Initial arrest appears to be primary cardiac arrest (non-traumatic
origin).
iii)
Patient has ROSC in the field.
iv)
Patient has altered mental status.
v)
Patient has a BP >100 systolic.
B.
Procedure: Place five (5) standard chemical ice packs in the following
locations:
i)
One on the neck covering both carotid arteries.
ii)
One in each of the axillae.
iii)
One over each of the femoral vasculature in the groin.
iv)
Consider other cooling measures (i.e. removal of the patient’s clothes,
turn on the ambulance AC in the patient compartment and direct air
flow over patient).
4.
Turn down oxygen to 4 lpm (as needed) to maintain Sp02 of >92% to <100%.
5.
Advise the Emergency Department personnel upon arrival that you have initiated
the cooling process.
6.
Obtain blood glucose.
ResQPOD® Procedure
Introduction
The ResQPOD circulatory enhancer provides a small, but important amount of resistance during
chest wall recoil. The resistance increases blood flow back to the heart, which increases the
preload of the heart.
Indications
Cardiopulmonary Arrest – Pulseless/Apneic Patient
Contraindications
1.
Cardiogenic Shock
2.
3.
4.
5.
6.
Pulmonary Edema
Chest Trauma
Flail Chest
<1 years of age
< 20 kg
Precautions
1.
2.
Use only if trained in the proper use of the device.
Breathing patients will not be able to tolerate this device.
Procedure
1.
Cardiac Arrest Patient, ResQPOD (Clear device with lights)
A.
Select airway adjunct (Mask, King, ET Tube)
B.
Continue CPR allowing complete chest re-coil after each compression
C.
Do not allow hyperventilation
i)
30:2 unprotected airway
ii)
protected airway/Lucas use- use timing lights
D.
Place ResQPOD between adjunct and bag-valve-mask with supplemental
oxygen and ensure the mask has a continuous tight seal
E.
Ensure ET/King is properly placed and secured with mechanical tube holder.
Patient must be placed in head block and C-Collar. Use caution so additional weight of
ResQPOD does not move ET/King.
F.
Place End Tidal CO2 detector in-line in this order; BVM, ResQPOD, CO2 detector,
ET/King/Mask, Patient.
G.
Document time ResQPOD is placed in circuit
H.
If ResQPOD fills with blood/emesis/fluid, remove and shake fluid out. Re-apply
and continue ventilations.
I. Only healthcare providers who are trained in the use of the ResQPOD should use
the device.
J.
Remove ResQPOD when the patient regains ROSC.