2.4 -Cardiac Arrest Prehospital Management of Cardiac Arrest HISTORY SIGNS and SYMPTOMS ASSESSMENT • Events leading to arrest • Unresponsive • Medical vs. Trauma • Estimated downtime • Apneic • V-fib vs. Pulseless V-tach • Past medical history, DNR • Pulseless • Asystole • Medications/Allergies • Pulseless Electrical Activity • Existence of terminal illness • (PEA) • Obvious signs of death • Causes (H’s and T’s) TREATMENT GUIDELINES **MEDICAL CONTROL* R-EMR E-EMT I-85 A-EMT I-99 P-PARAMEDIC Level II Intervention ***Higher levels of providers are responsible for lower level treatments*** • Initial Patient Contact • Evaluate for criteria of DOA or DNR Directive: If none, start CPR. Attach LUCAS. R • If ALS not available, proceed with Automated Defibrillator (AED) Procedure. • Implement Airway Management Procedures. Ventilate no more than 12 breaths/min • Obtain Blood Glucose Level. • Obtain and reassess vital signs every 5 minutes. • Secure airway using Blind Insertion Airway Device (BIAD) such as a King airway. • Determine patient destination and transportation mode. E • Transport to receiving facility. Do not delay for procedures when possible. • Notify receiving facility. Contact Medical Control as appropriate. • Assist ILS/ALS with Procedures. • Establish IV access with normal saline. Consider secondary IV access if time permits. • DO NOT DELAY TRANSPORT TO ESTABLISH VASCULAR ACCESS ONLY. I85 • Obtain IV access if not already established in another manner. • Consider correctable causes for arrest (H's and T's). See below. A • Consider D50 12.5-25g IV/IO for hypoglycemia • Assess rhythm and proceed to appropriate guideline: VF or Pulseless VT, PEA • Asystole. I99 • ALS preferred for all Cardiac Arrest incidents. • Assess rhythm. Continue with appropriate ACLS guidelines. P • Epinephrine 1mg 1:10,000 IV/IO every 3-5 minutes • Consider intubation. • For return of spontaneous circulation, go to Post Resuscitation Guidelines, and obtain 12 lead EKG; transmit when possible to Medical control. • **Contact Medical Control for suspected STEMI, or for further direction and assistance.** M Pearls: Reassess airway frequently and with every patient move. Adequate compressions and timely defibrillation are the keys to success. Priority is for uninterrupted CPR. If BVM or BIAD are successful to ventilate patient, intubation should be deferred until ROSC Hs and Ts: Hypovolemia, Hypoxia, Acidosis, Hyperkalemia, Hypothermia, Hypoglycemia/Hyperglycemia, Tablets or Toxins, Cardiac Tamponade, Tension Pneumothorax, Thrombosis (MI), Thromboembolism (PE), or Trauma. Maternal arrest: Treat the mother per appropriate protocol with immediate notification to Medical Control and rapid transport to the receiving facility. 2.4 -Cardiac Arrest-Pediatric Prehospital Management of Cardiac Arrest HISTORY SIGNS and SYMPTOMS ASSESSMENT • Events leading to arrest • Unresponsive • Medical vs. Trauma • Estimated downtime • Apneic • V-fib vs. Pulseless V-tach • Past medical history, DNR • Pulseless • Asystole • Medications/Allergies • Pulseless Electrical Activity • Existence of terminal illness • (PEA) • Obvious signs of death • Causes (H’s and T’s) TREATMENT GUIDELINES **MEDICAL CONTROL* R-EMR E-EMT I-85 A-EMT I-99 P-PARAMEDIC Level II Intervention ***Higher levels of providers are responsible for lower level treatments*** • Initial Patient Contact • Use Broselow Tape R • Evaluate for criteria of DOA or DNR Directive: If none, start CPR. Attach LUCAS. • If ALS not available, proceed with Automated Defibrillator (AED) Procedure. • Implement Airway Management Procedures. Ventilate no more than 12 breaths/min • Obtain Blood Glucose Level. • Obtain and reassess vital signs every 5 minutes. • Secure airway using Blind Insertion Airway Device (BIAD) such as a King airway or OPA. • Determine patient destination and transportation mode. E • Transport to receiving facility. Do not delay for procedures when possible. • Assist ILS/ALS with Procedures. • Establish IV access with normal saline. Consider secondary IV access if time permits. • DO NOT DELAY TRANSPORT TO ESTABLISH VASCULAR ACCESS ONLY. I85 • Obtain IV access via IO (Intraosseus) if not already established in another manner. • Consider correctable causes for arrest (H's and T's). See below. A • Consider D50 12.5-25g IV/IO >2yrs, <2 D25 at 2ml/kg, <1 month D10 at 5ml/kg (mix 1 ml D50 with 4ml NS) for BS <60 in child or <40 in newborn • Assess rhythm and proceed to appropriate guideline: VF or Pulseless VT, PEA , Asystole. I99 • ALS preferred for all Cardiac Arrest incidents. • Assess rhythm. Continue with appropriate PALS guidelines. P • Epinephrine 0.01 mg/kg IV/IO repeat every 3 minutes • Consider intubation. • For return of spontaneous circulation, go to Post Resuscitation Guidelines, and obtain 12 lead EKG; transmit when possible to Medical control. • Consider Sodium Bicarbinate 1.0 mEq/kg IV/IO • **Contact Medical Control for suspected STEMI, or for further direction and assistance.** M Pearls: Reassess airway frequently and with every patient move. Adequate compressions and timely defibrillation are the keys to success. Priority is for uninterrupted CPR. If BVM or BIAD are successful to ventilate patient, intubation should be deferred until ROSC Hs and Ts: Hypovolemia, Hypoxia, Acidosis, Hyperkalemia, Hypothermia, Hypoglycemia/Hyperglycemia, Tablets or Toxins, Cardiac Tamponade, Tension Pneumothorax, Thrombosis (MI), Thromboembolism (PE), or Trauma. Maternal arrest: Treat the mother per appropriate protocol with immediate notification to Medical Control and rapid transport to the receiving facility. .