Medical Cardiac Arrest Directives

non-traumatic cardiac arrest

in the following situations considered very elery transport ( minimum 1 analysus + defib + egres plan):
- pregnancy presumed ≥ 20 weekks
- known reversible causes

pt in refractory VF or pulsless VT consider:
1. double sequential Dfib
OR
2. ventor change
AND
3. trasnport following three doses (shocks)

persistant VF or pulsless VT after 3 consecutive shocks

age: ≥ 24 hours
loa: altered
other: VF or pulseless VT

≥ 24 hours
loa: altered
other: d-fib indicated

≥ 24 hours
loa: altered
other: anaphylaxis suspected as causative event

≥ 18 years old
loa: altered
other: non traumatic VF/pulseless VT of presumed cardiac arrest origin
- three consecutive standard shcocks by medics/fire

age: ≥ 16
loa: altered
other: arrest not witnessed by medics AND no ROSC after 20 min of resus AND no defibs delivered

NA

na

allergy/sensivity to epi

na

pregnancy presummed ≥ 20 weeks
suspected hypothermia
airway obstruction
non-opoioid drug overdose/toxicity

dose: 1 defib
initial: 2 j/kg
subsequent: 4 j/kg
int: 2 min
#: na

dose: 1 defib
initial: per RBHP manufacterer
subsequent: per RBHP manufacturer
int: 2 min
#: na

- considered medical TOR ( if applicable)
- early to consider TOR is extenuating circumstances or medics think its futile
- patch fails and/or no ROSC after 20 min, initiate transport

BHP might not authorize TOR when: location of pt, ETCo2, age, bystanders witnessed, bystander CPR, transport time, unusual case ( electrocution, hanging, toxicology)

cardiac arrets secondary to severe blunt/penetrating trauma

loa: altered
other: performed in 2 min intervals

age: ≥ 24 hours
loa: altered
other: VF or pulseless VT

≥ 24 hours
loa; altered
other: defib indicated

age: ≥ 16
loa: altered
HR: 0
RR: 0
other: no palpable pulse AND
no defibs delivered AND
rhythm asystole AND
no sings of life at any time since fully extricates OR sings of life when fully extricated with closes ED ≥ 30 min OR
rhyhtm PEA with closes ED ≥ 30 min

obviosuly dead per BLD standered
meet conditions of BLS DNR

rhythms other then VF or pulseless VT

non-shockable rhythm

< 16 years old
defibs delivered
sings of life at any time since fully extricated
PEA closest ED < 30 min
pt with penetratinf trauma to torso or head/neck and lead trauma hospital < 30 min away

dose: 1 defib
initial: 2 j/kg
int: na
#: 1

dose: 1 defib
inital: per RBHP
int: na
#: 1

dose: 1 defib ( with/without peds cable)
max: per RBHP
in: na
#:1

dose: 1 defib
max: per RBHP
in: na
#:1

- autorization of Trauma TOR
- if patch fails/ TOR does not aply, transport to closes appropriate reciving facility folowing 1st analysis/shock

newborn patient

age: < 24 hours
HR: < 100 bpm

age: < 24 hours
HR: < 60
other: after 30 seconds of PPVsing room air

obviously dead per BLS
presumed < 20 weeks

bviously dead per BLS
presumed < 20 weeks

pt with return of spontaneous circulation after resus was initiated

≥ 2 years
SPB: hypotensive
other: chest auscultation clear

fluid overload

- titrate 94-98%
- avoid hyperventilation, target ETCo2 30-40 mmhg with continous capnography

route: IV
infusion: 10 ML/kg
interval: immediate
reasses: 100 ml
max: 1000 ml

route: IV
infusion: 10 ML/kg
interval: immediate
reasses: 250 ml
max: 1000 ml

- initiating transport in parallel with treatment above

chest compression
defib
artificial ventilation
insetion of OPA, NPA, SGA
endotracheal intubation
transcutaneous pacing
advanced resus ( vasopressors, antiarrhythmics agents, opioid antagonsit)

pre-printed serial number in coompletions AND:
1. name of pt (first + last)
2. check box identifying:
a. current plan of treatment exists, with pt whishes when capable or consent from subsitute decision maker when pt is incapable ( CPR not in plan
b. physician's current opinion is that CPR will not benefit the pt and is not part of treatment plan, has beeen discused with pt/SDM
3. check box identifying professional designations of MD, RPN, RN or RN (EC) has signed
4. printed name of MD, RPN, RN, RN (EC)
5. signature by MD, RPN, RN, RN (EC)
6. date that form was signed was before the date of requested ambulance