VSA Medical arrest (BLS Cardiac Arrest):
Step 1: Confirm VSA (Absent carotid pulse) and have your partner/fire initiate CPR.
Step 2: Place defibrillator pads.
Step 3: Pause CPR and analyze ECG rhythm. (If non-shockable, move to step 5)
Step 4: If shockable, initiate compressions and charge monitor.Clear and deliver shock.
Step 5: Perform compressions for 2 minutes.
Repeat x4 rounds. After the 3rd analysis a TOR may be considered if:
Age >/=18 years
Arrest was not witnessed by EMS
No defibrillation was delivered
No ROSC was achieved
Contact BHP for direction at this time.
If the patient does not meet the criteria for a TOR, perform the 4th analysis and extricate, continuing to provide good quality CPR enroute to the closes ED.
ROSC:
In the event of a ROSC:
Confirm airway is secure and ventilations are adequate.
Target ETCO2 30-40mmHg, and SPO2 94-98%.
Obtain SBP Q5 minutes and consider fluid bolus if hypotensive (10cc/kg max 1000cc).
Extricate with autopulse in place if possible.
Obtain a 12-lead within 10 minutes unless patient re-arrests prior.
Re-arrest:
In the event of re-arrest, perform a single analysis/defibrillation and continue to closest ED.
OBVIOUS DEATH:
The patient can be considered non-workable in the following situations:
Transection
Decapitation
Visible decomposition
Putrefaction
or absence of vital signs and:
A grossly charred body
Gross rigor mortis
Dependant lividity
or
absent of vital signs with:
A valid DNR
Withhold resuscitation order
Medical certificate of death
Special Resuscitation situations
Consider early transport (after one analysis) for:
Pregnancy >/= 20 weeks
Hypothermia
FBAO
Non-opioid overdoses
Suspected PE
Other known reversible causes
Consider early extrication after the 3rd analysis for all pediatric patients.
Trauma arrest:
In the case of a trauma cardiac arrest, perform a single analysis/defibrillation and then initiate transport unless the criteria for trauma TOR are met.
Trauma TOR criteria:
Age >/= 16 years
HR = 0
RR = 0
No palpable pulses
No defibrillation delivered
Monitored HR of 0 or >0 (PEA) with the closest ED >/= 30 minutes away.
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