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

• • Consider withholding resuscitation if:

• • • No pulse and asystole or
    • Injuries incompatible with life

• • • • Contact Coroner

 

Criteria for Death/DNR ?

 

• No

 

• • Immediate continuous compressions
  • Rapid Transport

• • Cardiac monitor/AED

• • Initiate IV/IO

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

• • Treat correctable causes early

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

 

V-Fib/pulseless V-tach ?

 

• Yes

 

• • Defibrillate 2 joules/kg; all subsequent shocks at 4 joules/kg

• • Normal Saline or Lactated Ringers 20 mL/kg IV/IO; max 60 mL/kg or 1,000 mL

• • Epinephrine 0.01 mg/kg IV/IO; repeat every 3-5 min

• • Amiodarone (Cordarone) 5 mg/kg IV/IO; may repeat twice not to exceed adult dose

• • Place 2nd IV/IO when feasible

 

PEA >30

 

• Yes

 

• • Epinephrine 0.01 mg/kg IV/IO; repeat every 3-5 min

 

• • Normal Saline or Lactated Ringers 20 mL/kg IV/IO; max 60 mL/kg or 1,000 mL
  • Place 2nd IV/IO when feasible

 

Return of spontaneous circulation ?

 

• Yes

 

• • Notify receiving facility or contact Medical Control

 

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.
• Coroner Notification for High Morbidity Cases
• In cases in which EMS personnel believe that patient death may be imminent as a result of unnatural causes, the Coroner's Office shall be notified. This notification should be accomplished as soon as reasonably possible. It is the responsibility of the EMS Paramedic to communicate the patient condition with RTS to the EMS Communications Center in order that the Communication Center Staff can notify the On-Duty Coroner.