Adult Cardiac Arrest History Signs and Symptoms Differential • Events leading to arrest • Unresponsive • Medical vs. Trauma • Estimated downtime • Apneic • VF vs. Pulseless VT • Past medical history • Pulseless • Asystole • Medications • PEA • Existence of terminal illness • Primary Cardiac event vs. Respiratory arrest or Drug Overdose 68 Adult Cardiac Arrest Cardiac Arrest Code Commander Checklist Post ROSC Cardiac Arrest Checklist • Code Commander is identified • Airway • Time Keeper is identified ◦ ITD has been removed, ASSESS EtCO2 (should be >20 with good waveform) • Monitor is visible and a dedicated provider is viewing the rhythm with all leads attached ◦ Evaluate for post-resuscitation airway placement (e.g. ETT) • Confirm that continuous compressions are ongoing at 100-120 ◦ Mask is available for BVM in case advanced airway fails beats per minute • Breathing • Defibrillations are occurring at 2 minute intervals for shockable ◦ Check O2 supply and SpO2 to TITRATE to 94-99% rhythms ◦ Do not try to obtain a “normal” EtCO2 by increasing • O2 cylinder with adequate oxygen is attached to BVM respiratory rate • EtCO2 waveform is present and value is being monitored ◦ Avoid hyperventilation • ITD (Res-Q-Pod) is in place • Circulation • Vascular access has been obtained (IV or IO) with IV fluids being ◦ Assign a provider to maintain FINGER on pulse during all administered patient movements • Underlying causes (including tension PTX) are considered and ◦ Continuous visualization of cardiac monitor rhythm treated early in arrest ◦ Obtain 12 lead EKG; if STEMI evident, call CODE STEMI to • Basic demographics and brief history have been obtained the hospital • Gastric distention is not a factor ◦ Assess for & TREAT bradycardias < 60 bpm • Family is receiving care and is at the patient’s side if desired ◦ Obtain Blood Pressure -- Pressor agent(s) indicated for SBP < 90 or MAP < 60 ◦ When patient is moved, perform CONTINUOUS PULSE CHECKS and monitoring of cardiac rhythm • Other ◦ Once in ambulance, confirm pulse, breath sounds, SpO2, EtCO2, and cardiac rhythm ◦ Appropriate personnel present in the back of the ambulance for transport Pearls • Efforts should be directed at high quality and continuous compressions with limited interruptions and early defibrillation. • Consider early IO placement if available and / or difficult IV access anticipated. • DO NOT HYPERVENTILATE: If no advanced airway (supraglottic, ETT) compressions to ventilations are 30:2. If advanced airway in place ventilate 8–10 breaths per minute with continuous, uninterrupted compressions. • Head Up CPR, if available, is a time-sensitive intervention which should be performed as early as possible. • Do not interrupt compressions to place endotracheal tube. • Delay advanced airway management until after second shock and/or 2 rounds of compressions. • If resources allow, an endotracheal tube is preferred to avoid restriction of blood flow through the neck. • Resuscitation is based on proper planning and organized execution. Procedures require space and patient access. Make room to work. Utilize team approach by assigning responders to predetermined tasks. • Reassess, 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 MRCC and rapid transport. 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. • When faced with dialysis / renal failure patient experiencing cardiac arrest, consider early administration of Calcium Chloride and Sodium Bicarbonate to treat presumed hyperkalemia as possible etiology of arrest. • Consider possible CAUSE of arrest early: For example, resuscitated VF may be STEMI and more rapid transport is indicated. • Consider traditional “Hs and Ts” for PEA: Hypovolemia, Hypoxia, Hydrogen ions (acidosis), Hyperkalemia, Hypothermia, Hypo/ Hyperglycemia, Tablets/Toxins/Tricyclics, Tamponade, Tension pneumothorax, Thrombosis (MI), Thromboembolism (Pulmonary Embolism), Trauma 69.