Adult Cardiac Section Protocols ) ) ) other) Digitalis, Beta , AAA, , cardiac coronary (MI pulmonary Follow Go to to Go Protocol Return of Discontinue Circulation Resuscitation Hyperkalemia Trauma Spontaneous Spontaneous ( / AT ANY TIME Reversible Causes ) Post Resuscitation Deceased Subjects Policy PE myocardial infarction Thrombosis; Hypovolemia Hypoxia Hydrogen ion (acidosis Hypothermia Hypo Hypoglycemia Tension pneumothorax Tamponade; Toxins Thrombosis; ( s n pneumothorax nary embolus volemia thermia rkalemia xia iac tamponade overdose (Tricyclic Hypo Card Hypo Drug Massive Hypo Tensio Pulmo Acidosi Hype , blockersCalcium, channel blockers NO YES · Differential · · · · · · · · · ) min) / → ≥ 100 ( minutes 10 seconds 2 ≤ mg IV / IO IO ProcedureIO No minutes 5 000) 1 / IO IV / 40 units P Or 10, : 1 NO NO Protocol 11 pulses checks ess art tones art on auscultation Cardiac Monitor / ic on ECG ectrical activity Resuscitation Push Fast ≥ 2 inches) Push Fast Shockable Rhythm Criteriafor Death / Cardiac Arrest Protocol Apne No el No he Pulsel Repeat every 3 to Notify Destination or Vasopressin Review DNR Form / MOST Contact Medical Control Criteriafor Discontinuation Searchfor Reversible Causes Epinephrine ( Epinephrine · · Signs and Symptoms Signs · · Change Compressors every Begin Continuous CPR Compressions Begin Continuous IV Procedure Consider Chest Decompression Procedure May replaceor second first doseof epinephrine Limit changes ( Push Hard ( Push I I P P YES YES rs Pulseless Electrical Activity Electrical Pulseless / Asystole Adult wntime , or Living Will l history Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS ding to arrest renal disease italis cium channel blockers cted hypothermia cted overdose MOST life , cations Tricyclic Dig Beta blocke Cal Policy Follow Follow Protocol asystole Protocol Dialysis / if indicated Rigor mortis resuscitation Do not begin Renal Failure DNR Suspe · · · · Events lea End stage Estimated do Suspe Past medica Medi Decomposition Dependent lividity Blunt force trauma Deceased Subjects Rhythm Appropriate Injury incompatible with · · · · · History · · · Extended downtimewith Adult Asystole / Pulseless Electrical Activity Adult Cardiac Section Protocols Adult Cardiac Section

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 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. · If no IV / IO, drugs that can be given down ET tube should have dose doubled and then flushed with 5 ml of Normal Saline followed by 5 quick ventilations. IV/IO is the preferred route when available. · Consider each possible cause listed in the differential: Survival is based on identifying and correcting the cause. · Potential association of PEA with hypoxia so placing definitive airway with oxygenation early may provide benefit. · PEA caused by sepsis or severe volume loss may benefit from higher volume of normal saline administration. · Return of spontaneous circulation after Asystole / PEA requires continued search for underlying cause of cardiac arrest. · Treatment of hypoxia and hypotension are important after resuscitation from Asystole / PEA. · Asystole is commonly an end-stage rhythm following prolonged VF or PEA with a poor prognosis. · Sodium bicarbonate no longer recommended. Consider in the dialysis / renal patient, known hyperkalemia or tricyclic overdose at 50 mEq total IV / IO. · Discussion with Medical Control can be a valuable tool in developing a differential diagnosis and identifying possible treatment options. · Potential protocols used during resuscitation include Overdose / Toxic Ingestion, Diabetic and Dialysis / Renal Failure.

Protocol 11 Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS