Download Cardiac Arrest

Cardiac Arrest; Adult
History
Signs and Symptoms
·
·
·
·
·
·
·
·
Events leading to arrest
Estimated downtime
Past medical history
Medications
Existence of terminal illness
Decomposition
Rigor mortis
Dependent lividity
Blunt force trauma
Injury incompatible with
life
Extended downtime with
asystole
YES
Differential
·
·
·
·
·
Unresponsive
Apneic
Pulseless
Medical vs. Trauma
VF vs. Pulseless VT
Asystole
PEA
Primary Cardiac event vs. Respiratory
arrest or Drug Overdose
AT ANY TIME
Criteria for Death / No Resuscitation
Review DNR / MOST Form
Return of
Spontaneous
Circulation
NO
Begin Continuous CPR Compressions
Push Hard (≥ 2 inches) Push Fast (≥ 100 / min)
Change Compressors every 2 minutes
(Limit changes / pulses checks ≤ 10 seconds)
Do not begin
resuscitation
Follow
Deceased Subjects
Policy
Go to
Post Resuscitation
Protocol
AED Procedure if available
P
Cardiac Monitor
Shockable Rhythm
Shockable Rhythm
NO
Continue CPR
2 Minutes
Repeat and reassess
NO
YES
Shock Delivery
Continue CPR
2 Minutes
Repeat and reassess
Airway Protocol(s)
Follow
Asystole / PEA
Airway
Protocol(s)
as indicated
YES
Follow
VF / VT
Tachycardia
Airway
Protocol(s)
as indicated
Airway Protocol(s)
Notify Destination or
Contact Medical Control
Protocol 13
Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS
Adult Cardiac Section Protocols
YES
ALS Available
NO
Cardiac Arrest; Adult
Adult Cardiac Section Protocols
Pearls
· Efforts should be directed at high quality and continuous compressions with limited interruptions and early
defibrillation when indicated. Consider early IO placement if available and / or difficult IV access
anticipated.
· DO NOT HYPERVENTILATE: If no advanced airway (BIAD, ETT) compressions to ventilations are 30:2. If
advanced airway in place ventilate 8 – 10 breaths per minute with continuous, uninterrupted compressions.
· Do not interrupt compressions to place endotracheal tube. Consider BIAD first to limit interruptions.
· Breathing / Airway management after second shock and / or 2 rounds of compressions (2 minutes each
round.)
· Success is based on proper planning and execution. Procedures require space and patient access. Make room to
work. Consider Team Focused Approach assigning responders to predetermined tasks.
· Team Focused Approach / Pit-Crew Approach. Refer to optional protocol or development of local agency protocol.
· Reassess and document endotracheal tube placement and EtCO2 frequently, after every move, and at transfer of
care.
· Maternal Arrest - Treat mother per appropriate protocol with immediate notification to Medical Control and rapid
transport preferably to obstetrical center if available and proximate. Place mother supine and perform Manual Left
Uterine Displacement moving uterus to the patient’s left side. IV/IO access preferably above diaphragm.
Defibrillation is safe at all energy levels.
· Consider mechanical CPR (compression) device if available.
· Refer to Dialysis / Renal Failure protocol caveats when faced with dialysis / renal failure patient experiencing cardiac
arrest.
· Consider Opioid Overdose: Naloxone 2 mg IM / IV / IO / IN. EMT-B may administer Naloxone via IN route only. May
give from EMS supply.
· Follow manufacture's recommendations concerning defibrillation / cardioversion energy when specified.
Protocol 13
Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS