Definitions/ Qs
What are the 4 reasons to NOT start CPR?
1) Valid out of hospital DNR
2) Venous pooling
3) Rigor mortis
4) Obvious mortal wound
What are the medications used in a cardiac arrest (no ROSC)?
Epi
-push-epi, pre-measured, every 4 minutes
Amiodarone
-1st and 2nd dose; no need for more after that
Atropine
-0.5mg IVP over 30-60 sec., repeat every 3-5 min. till max 3mg (6 dosages)
Put the items in order for a correct cardiac arrest episode upon the first arrival to the scene:
1) Epi push
2) Confirm good CPR
3) BP, pulse oximetry, hand on radial and femoral arteries to confirm pulse, 12-lead EKG
4) ETT
5) Resume CPR
6) Confirm pulselessness/ place pads connected to monitor on the patient
7) If shockable rhythm, shock patient
8) Establish IO
9) Charge monitor, check pulse, pause CPR, shock if shockable
10) Amiodarone
2, 6, 7, 8, 1, 9, 5, 10, 4, 3
Define ROSC
Return Of Spontaneous Circulation
Why is obtaining a patient history important for the success of a cardiac arrest resuscitation?
Why the patient coded is equally important as running the code correctly. For example, if the patient overdosed on an opioid, then Narcan should be used relatively early in resuscitation efforts to reverse the effects of the drug.
You arrive on the scene to a 64-year-old male, not conscious, not breathing. The wife says she saw her husband collapse while fixing the living room ceiling fan. Fire is on the scene and performing quality CPR and has been for 15 minutes prior to your arrival. A Firefighter approaches you and hands you a valid out of hospital DNR for the patient. The wife is clearly distraught, begging Medics and Firefighters to bring her husband back, stating she wouldn't know what do do without him. Do you cease CPR?
There is technically no wrong answer to this question since it is a moral dilemma. You could technically call the end of resuscitation efforts there because of the DNR; however, at this point, the wife is the patient and requires the attempt of a resuscitation.
What medications can be used during a cardiac arrest for ROSC? (what should be prepped?)
Dopamine
0.25mg/kg IV
Epi Push
-1mg IVP
How often should you give Epi? What is the dosage of Epi Push during a cardiac arrest?
Every 4 minutes (every other round of CPR)
1mg IVP
Can a patient go back into a cardiac arrest after ROSC?
Yes; actually, it is expected. Most times it is not clear right off the bat as to why the patient has coded. If the reason for the code is not rectified, then the patient will relapse into a cardiac arrest.
Define the H & T's of a cardiac arrest
H: Hypovolemia
H: Hypothermia
H: Hypoxia
H: Hypo/hyperkalemia
H: Hydrogen ion (acidosis)
T: Tamponade
T: Tension pneumothorax
T: Toxins
T: Thrombosis, cardiac
T: Thrombosis, pulmonary
What are the 4 shockable rhythms?
1) VFib
2) Pulseless VTach
3) TDP
4) Afib w/ RVR and WPW
When is Magnesium Sulfate indicated during a cardiac arrest?
TDP
-2g IV over 2 min. (non-code TDP = 2g IV over 10 min.)
What is the 1st and 2nd dosage of Amiodarone during a cardiac arrest? Why not use more than 2 dosages?
1: 300mg IVP
2: 150mg IVP
Amiodarone can last in a patient's body for over a month; if 2 dosages doesn't work, a 3rd won't help.
When should you place the patient on an auto pulse?
After everything else is established; the auto pulse is for transport of the patient to the ambulance. Until you are at the point of looking for patient history and prepping for transport, this should not be a thought in your mind.
Are there any other causes of a Code not obviously stated in the H&Ts list?
Yes; Pulmonary Embolism, Myocardial Infarction, failed shock (cardiogenic, neurogenic), etc.
How should you prep for ROSC during a cardiac arrest?
Get cart/soft stretcher/backboard
Plan route to the ambulance
Plan help for transport (driver?)
Get the patient's history, demographics, meds
Help family
After 2 doses of Amiodarone and discovering they were ineffective.
What is the compression to the ventilation rate for the resuscitation of a neonate?
3 compressions to 1 ventilation
Why should you have a person checking the femoral and carotid pulses to the pulse detected on your monitor?
If the pulses detected by the individual do not line up with the monitor, it means the monitor is not analyzing the patient properly (could be dropped rhythms, could be monitor's oopsies, idk). It can also be a sign of the patient going back into a cardiac arrest.
How does treatment change between the average cardiac arrest and a trauma-induced cardiac arrest?
Trauma cardiac arrests need Trauma Gods/ER to save them; perform same cardiac arrest template, but mix prep work to transport patient in between work rather than at the end; patient needs to load and go
When should resuscitation be terminated?
1) One of the 4 reasons to begin CPR has been discovered
2) EtCO2 showing poor perfusion with good CPR and ventilations
3) ECG: no shockable rhythm
4) IV/IO: 5 Epi have been used (minimum)
5) Airway: advanced airway has been established and is pattened (iGel, King, ETT) with full O2
6) Call Medical Control
Qs: Setting? Scene safety? Scene security?
What is a serious side effect of magnesium sulfate?
Hypotension from vascular smooth muscle dilation
When would you add compressions to ventilation during resuscitation of a neonate?
After initial ventilation for 30-60 sec.
If HR is below 60 or absent
What is the 5 step process, in order, for a ROSC patient?
1) Hook everything up
-BP, SpCO2, EtCO2, EKG
2) Check everything out
-IV fluids, O2 supply
3) Tie everything down
-ETT, IO, O2 supply
4) Get on the road
-HOSPITAL! VAMANOS!
5) Get on the phone
-med control at ER
How does the treatment of an average cardiac arrest patient change when the patient is pediatric?
Smaller doses of medication, the focus is more on ventilation, compressions change (neonate 3 to 1, peds 15 to 1)