21 Questions
What is the duration of time to check for a pulse?
10 seconds
What is the medication administered after 2 minutes of CPR?
Epinephrine 1 mg IV/IO push
What is the recommended interval for repeating Epinephrine administration?
Every 3 to 5 minutes
What is the alternative medication to Amiodarone?
Lidocaine
What is the primary therapy for Cardiac Arrest victims?
High Quality CPR
What is the recommended method of administration for Amiodarone?
Peripheral vein or IO administration
What may indicate ROSC according to the protocol?
An abrupt sustained increase in ETCO2
When should the Waveform End Tidal CO2 be used according to the protocol?
Routinely in cardiac arrests
What is the recommended dose of fluid to be used with ET administration of drugs?
10 mL NS flush
What should happen to the body after TERMINATION OF RESUSCITATION INSIDE AN AMBULANCE?
It should be removed from the ambulance, assuming the ambulance is not the site of homicide
What is the preferred management of the traumatic arrest patient?
Surgical intervention at an appropriate verified trauma center
Why is traumatic arrest approached separately from primary cardiac arrest?
Due to the mechanism of injury and cause of cardiopulmonary arrest
What may exist in the post-traumatic circulatory arrest patient?
Severe hypovolemia
What is the current stance on the use of ACLS/PALS-type medications in traumatic arrest?
We do not recommend their use
What is contraindicated in the traumatic arrest patient?
Post-ROSC cooling
What should be considered in a situation where the mechanism of injury appears inconsistent with the patient’s condition?
A primary medical cause for the patient’s cardiac arrest
What is the minimum pulse rate required for a patient to meet the inclusion criteria for narrow complex tachycardia?
150
What is the duration of the QRS complex in narrow complex tachycardia?
Less than 0.12 seconds
What is the next step in the post-termination body movement protocol if the cause of death is unclear?
All of the above
What is the minimum age requirement for a patient to be considered for the narrow complex tachycardia protocol?
16 years old
What should be considered in the post-termination body movement protocol if the cause of death is likely homicide or child abuse?
Avoid body movement unless necessary for life safety and involve law enforcement and/or the coroner’s office
Study Notes
Ventricular Fibrillation/Tachycardia Adult w/o Pulse
- Patient's age is 16 years and older
- Patient is unresponsive
- Patient is without a pulse (checked for a maximum of 10 seconds)
AED Findings
- Ventricular fibrillation or ventricular tachycardia without a pulse
Protocol
- Continue CPR and care per SB204
- Defibrillate immediately at 360 Joules (biphasic equivalent or manufacturer's recommendation)
- Immediately resume CPR
- Perform CPR for 2 minutes before another pulse or rhythm check
- Search for possible causes as listed in SB204
- Administer Epinephrine 1 mg (10 ml of 0.1 mg/mL) IV/IO push
- Repeat every 3 to 5 minutes as long as arrest continues
- Administer Amiodarone 300 mg IV/IO push
- Repeat Amiodarone 150 mg IV/IO push in 3-5 minutes if still in VF/VTach
- Lidocaine may be substituted as: Lidocaine 1.5 mg/kg IV/IO push
- Repeat Lidocaine 0.5 to 0.75 mg/kg IV/IO in 3-5 minutes if still in VF/VTach
Notes
- High-quality CPR (SB204) is the mainstay of therapy for cardiac arrest victims
- If a pulseless patient is found to have agonal or gasping-type respirations, apply AED or quick-look paddles immediately
- Consider H's and T's (see SB204)
Traumatic Cardiac Arrest (Adult & Pediatric)
- Traumatic arrest from both blunt and penetrating trauma carries high rates of mortality
- The preferred management of the traumatic arrest patient is surgical intervention at an appropriate verified trauma center
- The protocol aims to delineate patients who would benefit best from resuscitative efforts
- Do not use ACLS/PALS-type medications including epinephrine/atropine in the setting of traumatic arrest
Narrow Complex Tachycardia w/Pulse (Unstable)
- Patient's age is 16 years and older
- No history of trauma or fever
- Pulse rate greater than 150
- Patient has signs of inadequate perfusion
Protocol
- Assure airway patency and administer oxygen to correct hypoxia
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