2014 february als cardiac arrest and rosc

7/17/2019 2014 February ALS Cardiac Arrest and ROSC

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Acute CoronarySyndromes: CardiacArrest and Return of

Spontaneous CirculationPresence Regional EMS

February 2014 ALS CE


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Describe the relationship o the chain o sur!i!alto successul resuscitation o the car"iac arrestpatient#

Re!ie$ A%A &LS gui"elines#

De'onstrate car"iac arrest 'anage'entollo$ing ACLS gui"elines# Discuss the inter!entions re(uire" to ensure goo"

outco'es $ith Return o Spontaneous Circulation# )utline the current technology or Let *entricular

Assist De!ices an" the role that EMS plays $ithpatients $ho ha!e these "e!ices#

Objectives


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Heart Disease

Car"io!ascular "isease is the nu'ber onecause o "eath in the +#S#, an" 'any ti'esthe -rst in"ication o this "isease is an

acute coronary e!ent

Car"iac arrest is the 'ost se!ere'aniestation o an acute coronary

syn"ro'e, an" $ith rapi" inter!ention EMSpro!i"ers can 'a.e the "i/erence bet$eenlie an" "eath


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American Heart AssociationFacts

to 'illion people a year see.

treat'ent or chest pain#) these, 2 'illion $ill actually ha!e acar"iac con"ition that a/ects the

coronary arteries#About 1# 'illion $ill su/er a heartattac.#

00,000 o these heart attac. patients

$ill "ie#250,000 of these patients will die withinthe rst hour of symptom onset.


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Cardiac Arrest Fe$ car"iac arrest patients sur!i!e outsi"e

a hospital $ithout a rapi" se(uence oe!ents#

Chain o sur!i!al3

Early recognition an" acti!ation o EMS ''e"iate bystan"er CPR

Early "e-brillation

Early a"!ance" car"iac lie support

ntegrate" post5arrest care


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6hy is CPR 'portant Stu"ies ha!e sho$n that the general population

$ill start CPR only 178 o the ti'e an" only 19 othat total is "one correctly

Chest Co'pressions can be starte" $ithin 1secon"s o arri!ing at the patient, $hereas air$ay'anage'ent -rst can "elay co'pressions by 152'inutes or 'ore

CPR prolongs the perio" "uring $hich"e-brillation can be e/ecti!e

Early CPR


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Rationale for EarlyDebrillation *entricular -brillation is the 'ost re(uent

rhyth' oun" in car"iac arrest

De-brillation is the 'ost e/ecti!e

treat'ent or *F Probability o successul "e-brillation

"i'inishes $ith ti'e

*F $ill lea" to asystole (uic.ly $ithoutproper treat'ent


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:%earts an" &rainsare going to "ie; Peter Saar MD

EMS has the 'ostopportunity toperor' CPR, so $eshoul" be goo" atperor'ing goo",(uality CPR

Early Debrillation


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!"#" AHA $uidelines


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1# Ma.e sure the scene is SAFEygen to>ic


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1mmediate Post Arrest Care /Return of Spontaneous Circulation2ROSC3

reat hypotension ?S&P I=0 '' %g@ Flui" &olus J152 liters

*asopressors

Epinephrine 0#150# 'cg7.g7'inute

Dopa'ine 510 'cg7.g7'inute


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1mmediate Post Arrest Care /Return of Spontaneous Circulation2ROSC3

n"uce" %ypother'ia not ollo$ing co''an"s

'pro!e" neurological reco!ery

82K 5 84K C or 12524 hours

Coronary reperusion SEM

May "o concurrently $ith hypother'ia


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A !entricular assist "e!ice?*AD@ is a 'echanicalpu'p thatBs use" tosupport the heart

he "e!ice ta.es bloo"ro' a lo$er cha'ber othe heart an" helps pu'p

it to the bo"y an" !italorgans, ust as a healthyheart $oul"#

+entricular Assist Devices


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4O.E: Pulse may not be palpable5 manual blood pressure often cannot be measured5 and

pulse o6imetry may be unreliable7 .&e patient0s automated blood pressure %ill usually be&ypotensive and pulse pressure %ill be narro%7

CR1.ER1A:

Presence o a let, right, or bilateral !entricular assist "e!ice

Serious signs or sy'pto's, inclu"ing3

Respiratory "iculty

Pul'onary e"e'a Chest pain

Signs or sy'pto's o shoc.

Potentially lethal "ysrhyth'ia

Altere" L)C7 syncope

FR-8(S .REA.9E4.:#7 141.1A( 9ED1CA( CARE#

2# Call or intercept per ERCEP CRERA#

Re)ion * Protocol+AD 2+entricular Assist Device3


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1(S-A(S .REA.9E4.:

1# Continue FR - 8(S .REA.9E4.7

2# stable, ollo$ appropriate 1(S-A(Sprotocol#

8# Auscultate heart# Continuous $hirling noise in"icates *AD is $or.ing,but e!en a caroti" pulse 'ay not be palpable#

4# Monitor ECN# there is a pulse, the rhyth' 'ay not correlate $ith it#

# S O*) or saline loc.#

# patient is "ehy"rate" an" lungs are clear a"'inister 20 'l ui"bolus o!er 10 'inutes# May repeat once, up to a total o 00'l or untilMAP H ''%g#

# )btain 12 lea" ECN# Follo$ appropriate protocol i SEM or"ysrhyth'ia present#

# &e sure patient brings bac. up po$er sources ?batteries, charger, etc#@,an" han" pu'p ?i applicable@#

=# Strongly consi"er transporting a *AD .no$le"geable a'ily 'e'ber$ith patient#

10#nspect *AD control or 'o"el na'e an" alar's# +se color co"e oratlas# Controller $ill usually be locate" at the $aist#

11#For *AD alar's or *AD 'alunction, please see *AD E'ergency CareNui"elines#

Re)ion * Protocol+AD 2+entricular Assist Device3


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+AD atlas:http377$$$#'yl!a"#co'7assets7e'sQ"ocs720185-el"5gui"e#p"

SPEC1F1C S1.A.1O4S:

1# *AD is alar'ing, ollo$ 'anuacturerBs instructions or loo. at *AD atlas# Atte'ptto contact *AD Specialist !ia 'anuacturerBs phone nu'ber ?on 'achine or $alletcar"@#

2# :(o% ;o% alarmternal pacing#

For %eartMate *E, .eep current I 40 'A#

For horatec P*AD $7 LC the nee" to pace is !ery rare since it is a &i*AD#

=7 CPR s&ould 4O. be performed on patients %it& .&oratec P+AD %- .(C 117# in"icate", CPR 'ay be peror'e" on patients $ith3 %eart6are %*AD, *entrAssist

L*AD, %eartMate , or ar!i. 2000 Flo$Ma.er#

# a *AD that eatures a han" pu'p ?%eartMate *E, or horatec P*AD $7 LC @loses po$er or the 'otor ails an" there is no o$ on 'eter an" no nor'al 'achinesoun" o!er the precor"iu', han" pu'ping is in"icate"# he han" pu'ping rateshoul" be 0 to =07'inute# Foot pu'ping is acceptable#

+AD 2+entricular Assist Device3Care $uideline
http://www.mylvad.com/assets/ems_docs/2013-field-guide.pdfhttp://www.mylvad.com/assets/ems_docs/2013-field-guide.pdfhttp://www.mylvad.com/assets/ems_docs/2013-field-guide.pdfhttp://www.mylvad.com/assets/ems_docs/2013-field-guide.pdf


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Ans$er the ollo$ing (uestions as a group# DP% site co"e3 +se site co"e assigne" to your

agency or 2014# "oing this CE in"i!i"ually, please e5'ail your

ans$ers to3 Shelley#Peel'anTpresencehealth#org +se :February 2014 ALS CE; in subect bo>#Uou $ill recei!e an e5'ail con-r'ation# Print this

con-r'ation or your recor"s, an" "ocu'ent the CEin your PREMSS CE recor" boo.#

Revie%
mailto:[email protected]:[email protected]


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Scenario # 44 year ol" 'ale at a local gol course

sitting in the club house co'plaining ochest pain# As you begin your assess'ent,he loses consciousness an" beco'espulseless an" apneic# he car"iac 'onitorsho$s this rhyth'3


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Scenario #

1# Accor"ing to the Region protocols, $hatis the appropriate ne>t step in treating thispatientV

A# Pro!i"e 2 'inutes o CPR prior to"e-brillation#

nitiate CPR, secure the air$ay an"establish !ascular access

C# ''e"iately "e-brillate at 80 ore(ui!alent biphasic shoc.

D# Deli!er a synchroniGe" shoc. at 200


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Scenario#

2# rue7False3 Ater "e-brillation you shoul"i''e"iately resu'e CPR an" continue or2 'inutes#

8# Accor"ing to the Region protocols, $hatis the 'a>i'u' "ose o a'io"arone that'ay be gi!en to this patientV


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Scenario !

=2 year ol" 'an in the nursing ho'e#Foun" in car"iac arrest# o DR present#

he car"iac 'onitor sho$s this rhyth'3


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4# Accor"ing to the Region protocols, $hatis the appropriate ne>t step in treating thispatientV

A# &egin CPR, initiate !ascular access an" 'anage

the air$ay ''e"iately "e-brillate an" then resu'e CPR

C# &egin CPR an" prepare to pace the rhyth'

D# Do not start resuscitation

Scenario !


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# 6hat is the appropriate ratio oco'pressions to breaths in a"ult CPR $ith2 rescuersV

# 6hat 'e"ication?s@ $oul" be appropriateor treating this rhyth'V

Scenario !


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# Accor"ing to the 2010 ACLS gui"elines,$hat are the 4 co'ponents o Post Car"iacArrest Care ollo$ing return ospontaneous circulationV

# rue7False3 All *ADBs 'ay be let on "uring"e-brillation#

=# rue7False3 CPR 'ay be peror'e" on any

patient $ith a *AD regar"less o the'o"el#


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1# C2# rue

8# 40'g

4# A# 8032

# Epinephrine 1310,000

Ans%ers


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# )pti'iGe !entilation an" o>ygenation,treat hypotension, consi"er in"uce"hypother'ia an" coronary reperusion

# rue

=# False

Ans%ers

2014 february als cardiac arrest and rosc

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