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
    • See COG 1.4

• • • Contact Coroner

 

Criteria for Death/DNR ?

 

• No

 

• • Rapid Transport
  • Immediate continuous compressions

• • Cardiac monitor/AED

• • Initiate IV/IO

• • Place BIAD and provide 20-30 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 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 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:

 

• If cardiac arrest is believed to be caused by a medical etiology, follow medical cardiac arrest COG
• Request blood products early
• Fluid should be given in increments of 20 mL/kg, reassess after each bolus.
• 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 advanced airway placement and EtCO2 frequently, after every move, and at transfer of care.