- Past medical history
- Events leading to arrest
- End stage renal disease
- Estimated downtime
- Suspected hypothermia
- Suspected overdose
- DNR form or living will
- No electrical activity on EKG
- Ventricular fibrillation/ventricular tachycardia
- No auscultated heart tones
- Potassium (hypo/hyper)
- Drug overdose
- Device error/artifact
Criteria for Death/DNR
- See COG 1.4 for criteria for death/withholding resuscitation
- Contact Medical Control or Coroner
Criteria for Death/DNR?
- Cardiac monitor / AED
- Treat correctable causes early
- Place BIAD and provide 8-10 breaths per minutes
- Initiate IV/IO
- Defibrillate 200, 300,360 joules
- All subsequent shocks at 360 joules
- Epinephrine 1 mg IV/IO repeat every 3-5 mins.
- Amiodarone (cardarone) 300 mg IV/IO repeat once at 150 mg.
- Place 2nd VI/IO when feasible
Asystole / PEA?
- Place 2nd IV/IO if necessary
Return of spontaneous circulation?
- Epinephrine given every 3-5 minutes, max 4 doses. Contact medical control to request more doses.
- CPR 100-120 compressions per minute and at a depth of no less than 2 inches with interruptions less than 5 seconds.
- Monitor in paddles mode with metronome on.
- Consider Calcium Gluconate (Kalcinate) 10-20 mL IV, followed by Normal Saline 100 mL IV and Sodium Bicarbonate 1 mEq/kg IV in hemodialysis patient early in the resuscitation.
- If patient is receiving shocks from an automated internal cardiac defibrillator (AICD), wait 30-60 seconds after the internal shock to analyze the rhythm and then treat the patient as if the AICD was not present. Placement of the difibrillator pads should be approximately 3 inches away from the device if possible. Posterior/anterior placement is acceptable.
- If patient has signs/symptoms of CPR-induced consciousness, consider Ketamine 1 mg/kg IV/IO (Max single dose 100 mg)
- If patient is in persistent v-fib/v-tach, administer Lidocaine 1 mg/kg IV/IO after max Amiodarone dose.
- If patient is in torsades de pointes or persistent v-fib/v-tach, administer Magnesium Sulfate 2 grams/4 mL slow IV push over 2 minutes.
- Always confirm asystole in more than one lead.
- Only move the patient enough to make adequate room to work.
- All resuscitations initiated at the jail must be transported.
- Transport patients with persistent V-fib/V-tach.
- Assign a team resuscitation leader and utilize checklist.
- Reassess and document endotracheal tube placement and EtCO2 frequently, after every move, and at transfer of care.