Ensure adequate space to work
The following is listed in the order of importance; each rescuer has a specific job during the arrest:
FIRST CREW ON SCENE
- Begin continuous CPR compressions; push hard (adult: >2 inches; child: >1½ inches) push fast (100-120/min); change compressors every 2 min (limit changes/pulse checks to <5 sec) during entire arrest
- Attach AED/monitor and defibrillate as necessary; provide ventilations with BVM
- First and second rescuers rotate every 2 min
SECOND CREW ON SCENE
- Assumes airway; consider BIAD/intubation; compressions should not be stopped to intubate
- Establish Team Leader/Code Commander: Utilize Cardiac Arrest Checklist
- Initiate IV/IO and administer appropriate medications at request of code commander
- ALL CREWS
- Follow appropriate arrest protocols
FIRST/SECOND OR THIRD RESCUER
- Once advanced airway is in place, ventilate every 6-8 sec; DO NOT interrupt compressions except for changes/pulse checks
- Continue cardiac arrest protocol
- Responsible for patient care
- Ensures high quality compressions
- Ensures frequent compressions changes
- Responsible for communication with family
- Operates monitor; utilizes the event button
- Measures medications and gives to 5th rescuer at time of administration
- Ensuring high quality compressions with minimal interruptions takes priority.
- Adequate compressions with timely defibrillation are the keys to success.
- Monitor in paddles mode with metronome on.
- Do not hyperventilate! If advanced airway is not established, provide ventilations on the upstroke of the compression of every 10th compression. Once advanced airway is in place, ventilate at a rate of 8-10 breaths per minute.
- Each breath should be administered over 1 second with just enough air to notice chest rise.
- Provide compressions while monitor/AED is charging.
- Keep all breaks in compressions to less than 5 seconds.
- Consider possible CAUSE of arrest early: For example, resuscitated V-fib may be a STEMI and more rapid transport is indicated.
Consider traditional ACLS "H's and T's" for PEA
- Hypovolemia, Hypoxia
- Hydrogen ions (acidosis)
- Tension pneumothorax
- Thrombosis (MI)
- Thromboembolism (Pulmonary Embolism)
, consider utilizing relevant protocols in conjunction:
- Maternal Arrest - Treat mother per appropriate protocol with immediate notification to (Medical Control) and rapid transport.