BLS Cardiac arrest management ADULT patient:
This is probably the first thing that comes to mind when people think of what paramedics do. Thankfully, it doesn't actually make up a major percentage of our calls (I hate doing CPR, but who doesn't). The BLS cardiac arrest may vary from service to service, depending upon the type of equipment you use and how medical direction wants things to run. In my service we use manual interpretation and defibrillation. Some places use semi-automated, and some services may use AEDs. Whatever the case, the protocol is essentially the same:
Step 1: Confirm the patient is VSA by checking for a carotid pulse. If a pulse is present, move on in your CAB assessment. If not, this is a code. Move on to step 2.
Step 2: Initiate compressions while defibrillator pads are placed.
Step 3: Stop CPR and perform a rhythm analysis. If shockable, initiate compressions during charging, and then stop to shock. If not shockable, resume compressions.
Step 4: Establish an airway, and continue compressions at a 30:2 ratio for 2 minutes.
Step 5: Repeat Step 3.
Perform CPR and ventilation in 2 minute cycles, with a rhythm check/defibrillation every 2 minutes x4 cycles. If the patient is over 18 yrs of age, the arrest was unwitnessed by EMS, no defibrillation was delivered, and no ROSC has been achieved it is appropriate to contact medical direction for a termination of resuscitation after 3 analyses.
You should consider early transport (following the first analysis) if:
The patient is >/=20 weeks pregnant.
Foreign body airway obstruction.
Hypothermic cardiac arrest.
Non-opioid medication overdose.
Suspected PE as causative event.
Other known reversible cause is present.
Pediatric patients should be extricated following the 3rd analysis. We don't terminate resuscitation on these patients outside of the hospital setting.
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