History:

 

• Past medical history
• Medications
• Events leading to arrest
• End stage renal disease
• Estimated downtime
• Suspected hypothermia
• Suspected overdose
• DNR form or living will

 

Significant Findings:

 

• Unresponsive
• Pulseless
• Apneic
• No electrical activity on EKG
• Ventricular fibrillation/ventricular tachycardia
• No auscultated heart tones

 

Differential:

 

• Medical/trauma
• Hypoxia/pulmonary
• Potassium (hypo/hyper)
• Drug overdose
• Acidosis
• Hypothermia
• Device error/artifact

 

Criteria for Death/DNR

 

• Yes

 

Withhold Resuscitation:

 

• See COG 1.4 for criteria for death/withholding resuscitation

• • Contact Medical Control or Coroner

 

Criteria for Death/DNR?

 

• No

• • Refer to Team Approach CPR
  • Immediate continuous compressions

• • Cardiac monitor / AED
  • Treat correctable causes early
  • Place BIAD and provide10 breaths per minutes
  • Initiate IV/IO

 

V-Fib/Pulseless V-Tach?

 

• Yes

• • 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.
  • Following 3rd shock, Change Pad Position and/or Replace Pads (Vector Change)
  • Place 2nd VI/IO when feasible

 

Asystole / PEA?

 

• Yes

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

• • Place 2nd IV/IO if necessary

 

Return of spontaneous circulation?

 

• YES

 

• • See Post Resuscitation Protocol

 

• NO

 

• • Consider Discontinuation of Prehospital Resuscitation Protocol

 

PEARLS:

 

• Epinephrine given every 3-5 minutes, max 4 doses if no change in PEA or Asystole, see Discontinuation of Resuscitation policy or 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.