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

 

Withhold resuscitation: ?

 

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

 

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

 

Criteria for Death/DNR

 

• Yes

 

• • See COG 1.4 for criteria for death/withholding resuscitation
  • Contact Coroner

 

• No

 

• • Rapid Transport

• • Immediate continuous compressions

• • Cardiac monitor/AED

• • Initiate IV/IO

• • Place BIAD and provide 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 200 joules, 300 joules, 360 joules;

• • all subsequent shocks at 360 joules
  • Following 3rd shock, Change Pad Position and/or Replace Pads (Vector Change)

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

• • Place 2nd IV/IO when feasible

 

PEA > 30 ?

 

• Yes

 

• • 1 Liter Normal Saline

 

• • 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:

 

• If cardiac arrest is believed to be caused by a medical etiology, follow medical cardiac arrest COG.
• 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.