CPR

 

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

 

FIRST RESCUER

 

  • 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

 

SECOND RESCUER

 

  • Attach AED/monitor and defibrillate as necessary; provide ventilations with BVM
  • First and second rescuers rotate every 2 min

 

SECOND CREW ON SCENE

 

THIRD RESCUER

 

  • Assumes airway; consider BIAD/intubation; compressions should not be stopped to intubate; place resQpod

 

FOURTH RESCUER

 

  • Establish Team Leader/Code Commander: Utilize Cardiac Arrest Checklist

 

FIFTH RESCUER

 

  • 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

 

CODE COMMANDER

 

  • 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

 

PEARLS:

 

  • 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)
    • Hyperkalemia
    • Hypothermia
    • Hypo/Hyperglycemia
    • Tablets/Toxins/Tricyclics
    • Tamponade
    • Tension pneumothorax
    • Thrombosis (MI)
    • Thromboembolism (Pulmonary Embolism)
    • Trauma.
  • When considering CAUSE , consider utilizing relevant protocols in conjunction:
  • Maternal Arrest - Treat mother per appropriate protocol with immediate notification to (Medical Control) and rapid transport.