History:

 

• Past medical history
• Medications
• End stage renal disease
• Estimated downtime
• Suspected hypothermia
• Suspected overdose
• DNR form

 

Significant Findings:

 

• Unresponsive
• Pulseless
• Apneic
• No electrical activity on EKG
• V-fib/V-tach
• No auscultated heart tones

 

Criteria for Death/DNR

 

• Yes

 

Withhold resuscitation: ?

 

• • No pulse and asystole or
  • PEA <30 bpm or
  • Injuries incompatible with life

 

 

 

• • Contact Corner

 

• • Consider terminating resuscitation if at any time patient presents with asystole or wide complex PEA   < 30

 

• No

 

• • Rapid Transport

 

 

 

• • Immediate continuous compressions

 

 

 

• • Cardiac monitor/AED

 

 

 

• • Initiate IV/IO

 

 

 

• • Place advanced airway and provide 8-10 breaths per minute

• • Treat correctable causes early
  • Attach resQpod

• • Perform bi-lateral pleural decompressions if penetrating or blunt force chest trauma

 

V-fib/pulseless V-tach ?

 

• Yes

 

 

 

• • Defibrillate 200 joules, 300 joules, 360 joules;

• • all subsequent shocks at 360 joules

• • Initiate Therapeutic Hypothermia

• • Epinephrine 1 mg IV/IO; repeat every 3-5 min
  • Amiodarone (Cordarone) 300 mg IV/IO; repeat once at 150 mg

 

 

• • Place 2nd IV/IO when feasible

 

PEA > 30 ?

 

• Yes

 

 

 

• • Epinephrine 1 mg IV/IO; repeat every 3-5 min

 

 

 

• • Place 2nd IV/IO when feasible

 

Return of spontaneous circulation ?

 

• Yes

 

• • Notify receiving facility or contact Medical Control

 

• No

 

• • Consider Discontinuation of Prehospital Resuscitation Protocol

 

PEARLS:

 

• Hangings are not considered trauma. See appropriate medical protocol.
• Always confirm asystole in more than one lead.
• Assign a team resuscitation leader and utilize checklist.
• Place monitor in paddles mode with metronome on.
• Reassess and document endotracheal tube placement and EtCO2 frequently, after every move, and at transfer of care.
• Upload call summary to "QI" upon completion of call.

• A Situational Awareness Report still must be provided to GCEMS dispatch on trauma calls.
• An initial scene report should include:
  • Type and/or cause of incident.

• • Approximate number of patients.
  • Severity level of injuries (Priority Levels), RTS and if a C-unit is necessary.
  • Problems accessing scene for incoming resources