CARDIAC ARREST / MEDICAL
ALL LEVELS
DESIGNATION OF CONDITION
Signs and symptoms include an unresponsive, apneic patient with absent carotid pulses. If patient does not meet Termination of Resuscitation guidelines, continue with the following protocol.
EMPHASIS ON PATIENT CARE
6. Uninterrupted Effective CPR using pit crew approach if possible, defibrillation and ACLS intervention as rapidly as possible
a. Apply AED and follow prompts
7. Patients in cardiac arrest should be managed in the field; all cardiac patients not experiencing arrest require minimal scene times and expeditious transport.
8. If the patient has a return of spontaneous circulation (ROSC) (sustained palpable pulses and measurable blood pressure), the patient should be transported to the closest appropriate facility.
9. All patients in cardiac arrest require immediate CPR, airway management and ventilations with oxygen (apply NRB mask at high flow for first two cycles of CPR). CPR and initial defibrillation take precedence over advanced airway management unless the airway cannot be managed with BLS maneuvers.
10. Defibrillation of the VF/ VT patient should occur as soon as possible
AEMT
11. Establish IV/IO access and flush to confirm patency.
12. Administer Epinephrine, IV/IO. See Special Notes below for approved dosing.
CARDIAC ARREST / MEDICAL
PARAMEDIC
4. Notes on intubation and oxygenation:
a. Apply NRB mask with high flow oxygen during first two cycles of CPR.
b. Then place nasal cannula to patient at 15 liters/minute prior to and during intubation attempts. It may be necessary to place bilateral NPAs.
5. Any patient who presents in cardiac arrest assumed to be from a medical cause will have CPR performed on scene for a minimum of 30 minutes. If ROSC is achieved at any time during resuscitation efforts the patient will be transported to the closest most appropriate hospital.
6. If after 30 Minutes the patient remains in Cardiac arrest, Medical Control should be contacted.
7. The following information should be collected if available, and relayed to medical control for further instructions:
The Patient’s:
• Age
• PMH
• General health (skin turgor, muscle tone, mobility of patient prior to arrest)
• Last time patient was seen alive
• Witnessed arrest
• Bystander CPR
• Pupillary Response
• Temperature
• Initial and current cardiac Rhythm
• Current ETCO2 reading
• Family wishes of resuscitation efforts
7. Resuscitation efforts may be terminated in the field if the patient meets the requirements for TOR guidelines, or with medical direction approval and if ALL of the following criteria are met:
a. CPR and ALS interventions have been attempted for at least 30 minutes,
b. No ROSC at any time during resuscitation efforts
c. The arrest is not the result of hypothermia
d. ETCO2 <15
e. Absence of Palpable Carotid/Femoral pulses
f. Family is accepting of the decision to terminate efforts for resuscitation.
g. The patient does not have an LVAD in place
8. All patients with a LVAD (left ventricular assist device) in cardiac arrest should be transported unless there is an active DNR.
9. The patient may be transported prior to reaching the 30-minute benchmark if responders feel that staying on scene does not promote good patient care or exposes them to harm or there are other mitigating circumstances.
Use of NALOXONE (Narcan) in cardiac arrest. Do not routinely administer NALOXONE. Use only when strong suspicion of opioid overdose exists such as prescription opioids, paraphernalia, or history suggestive of opioid use/abuse. NALOXONE has been shown to be ineffective once there is cardiac standstill.
EPINEPHRINE DOSING IN CARDIAC ARREST SPECIAL NOTES
Shortages of EPINEPHRINE 1:10,000 are necessitating alternate dosing for cardiac arrest patients. EPINEPHRINE administration in cardiac arrest patients is associated with improved ROSC rates but no dosing regimen has been shown to be superior in terms of ultimate survival. The following dosing regimens are acceptable in cardiac arrest patients when EPINEPHRINE 1:10,000 is unavailable or rationed. See DILUTION TECHNIQUE at the end of this section to create 1:10,000 doses.
1. AHA recommended dosing if EPINEPHRINE available: 1 mg. IV/IO q 3-5 minutes. No limitation on number of doses given.
2. EPINEPHRINE 1 mg. q 5-10 minutes IV/IO. No limitation on number of doses given.
3. EPINEPHRINE 1 mg. IV/IO followed by infusion.
a. Infusion: Mix 3 mg. (3 vials of 1 mg. 1:1,000) into a 1,000 cc bag of crystalloid solution and run so that bag is infusing throughout the 30 minute resuscitation.
4. EPINEPHRINE infusion only.
EPINEPHRINE DILUTION TECHNIQUE TO ACHIEVE 1:10,000 FOR BOLUS (EMT-I, P)
1. Use a 10 cc Flush Syringe.
2. Squirt out 1 cc.
3. Draw up 1 cc of EPINEPRHINE 1:1,000 into the syringe. Mix.
4. This renders a 1 mg dose of 1:10,000 which can be given as a bolus.
5. If Flush Syringe not available use 10 cc syringe and draw out 9 cc’s of NS from a bag. Then draw up the EPINEPHRINE.
ALL LEVELS
DESIGNATION OF CONDITION
Signs and symptoms include an unresponsive, apneic patient with absent carotid pulses. If patient does not meet Termination of Resuscitation guidelines, continue with the following protocol.
EMPHASIS ON PATIENT CARE
6. Uninterrupted Effective CPR using pit crew approach if possible, defibrillation and ACLS intervention as rapidly as possible
a. Apply AED and follow prompts
7. Patients in cardiac arrest should be managed in the field; all cardiac patients not experiencing arrest require minimal scene times and expeditious transport.
8. If the patient has a return of spontaneous circulation (ROSC) (sustained palpable pulses and measurable blood pressure), the patient should be transported to the closest appropriate facility.
9. All patients in cardiac arrest require immediate CPR, airway management and ventilations with oxygen (apply NRB mask at high flow for first two cycles of CPR). CPR and initial defibrillation take precedence over advanced airway management unless the airway cannot be managed with BLS maneuvers.
10. Defibrillation of the VF/ VT patient should occur as soon as possible
AEMT
11. Establish IV/IO access and flush to confirm patency.
12. Administer Epinephrine, IV/IO. See Special Notes below for approved dosing.
CARDIAC ARREST / MEDICAL
PARAMEDIC
4. Notes on intubation and oxygenation:
a. Apply NRB mask with high flow oxygen during first two cycles of CPR.
b. Then place nasal cannula to patient at 15 liters/minute prior to and during intubation attempts. It may be necessary to place bilateral NPAs.
5. Any patient who presents in cardiac arrest assumed to be from a medical cause will have CPR performed on scene for a minimum of 30 minutes. If ROSC is achieved at any time during resuscitation efforts the patient will be transported to the closest most appropriate hospital.
6. If after 30 Minutes the patient remains in Cardiac arrest, Medical Control should be contacted.
7. The following information should be collected if available, and relayed to medical control for further instructions:
The Patient’s:
• Age
• PMH
• General health (skin turgor, muscle tone, mobility of patient prior to arrest)
• Last time patient was seen alive
• Witnessed arrest
• Bystander CPR
• Pupillary Response
• Temperature
• Initial and current cardiac Rhythm
• Current ETCO2 reading
• Family wishes of resuscitation efforts
7. Resuscitation efforts may be terminated in the field if the patient meets the requirements for TOR guidelines, or with medical direction approval and if ALL of the following criteria are met:
a. CPR and ALS interventions have been attempted for at least 30 minutes,
b. No ROSC at any time during resuscitation efforts
c. The arrest is not the result of hypothermia
d. ETCO2 <15
e. Absence of Palpable Carotid/Femoral pulses
f. Family is accepting of the decision to terminate efforts for resuscitation.
g. The patient does not have an LVAD in place
8. All patients with a LVAD (left ventricular assist device) in cardiac arrest should be transported unless there is an active DNR.
9. The patient may be transported prior to reaching the 30-minute benchmark if responders feel that staying on scene does not promote good patient care or exposes them to harm or there are other mitigating circumstances.
Use of NALOXONE (Narcan) in cardiac arrest. Do not routinely administer NALOXONE. Use only when strong suspicion of opioid overdose exists such as prescription opioids, paraphernalia, or history suggestive of opioid use/abuse. NALOXONE has been shown to be ineffective once there is cardiac standstill.
EPINEPHRINE DOSING IN CARDIAC ARREST SPECIAL NOTES
Shortages of EPINEPHRINE 1:10,000 are necessitating alternate dosing for cardiac arrest patients. EPINEPHRINE administration in cardiac arrest patients is associated with improved ROSC rates but no dosing regimen has been shown to be superior in terms of ultimate survival. The following dosing regimens are acceptable in cardiac arrest patients when EPINEPHRINE 1:10,000 is unavailable or rationed. See DILUTION TECHNIQUE at the end of this section to create 1:10,000 doses.
1. AHA recommended dosing if EPINEPHRINE available: 1 mg. IV/IO q 3-5 minutes. No limitation on number of doses given.
2. EPINEPHRINE 1 mg. q 5-10 minutes IV/IO. No limitation on number of doses given.
3. EPINEPHRINE 1 mg. IV/IO followed by infusion.
a. Infusion: Mix 3 mg. (3 vials of 1 mg. 1:1,000) into a 1,000 cc bag of crystalloid solution and run so that bag is infusing throughout the 30 minute resuscitation.
4. EPINEPHRINE infusion only.
EPINEPHRINE DILUTION TECHNIQUE TO ACHIEVE 1:10,000 FOR BOLUS (EMT-I, P)
1. Use a 10 cc Flush Syringe.
2. Squirt out 1 cc.
3. Draw up 1 cc of EPINEPRHINE 1:1,000 into the syringe. Mix.
4. This renders a 1 mg dose of 1:10,000 which can be given as a bolus.
5. If Flush Syringe not available use 10 cc syringe and draw out 9 cc’s of NS from a bag. Then draw up the EPINEPHRINE.