Podcast
Questions and Answers
What is the duration of time to check for a pulse?
What is the medication administered after 2 minutes of CPR?
What is the recommended interval for repeating Epinephrine administration?
What is the alternative medication to Amiodarone?
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What is the primary therapy for Cardiac Arrest victims?
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What is the recommended method of administration for Amiodarone?
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What may indicate ROSC according to the protocol?
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When should the Waveform End Tidal CO2 be used according to the protocol?
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What is the recommended dose of fluid to be used with ET administration of drugs?
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What should happen to the body after TERMINATION OF RESUSCITATION INSIDE AN AMBULANCE?
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What is the preferred management of the traumatic arrest patient?
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Why is traumatic arrest approached separately from primary cardiac arrest?
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What may exist in the post-traumatic circulatory arrest patient?
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What is the current stance on the use of ACLS/PALS-type medications in traumatic arrest?
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What is contraindicated in the traumatic arrest patient?
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What should be considered in a situation where the mechanism of injury appears inconsistent with the patient’s condition?
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What is the minimum pulse rate required for a patient to meet the inclusion criteria for narrow complex tachycardia?
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What is the duration of the QRS complex in narrow complex tachycardia?
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What is the next step in the post-termination body movement protocol if the cause of death is unclear?
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What is the minimum age requirement for a patient to be considered for the narrow complex tachycardia protocol?
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What should be considered in the post-termination body movement protocol if the cause of death is likely homicide or child abuse?
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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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