C301
- Initiate CPR compressions at 100-120/min rate, 2-2.5 inches in depth, 30 compressions and 2 breaths, and rotate compressors every 2 minutes. Minimize all interruptions to compressions.
- Attach AED or defibrillator to patient as soon as possible and analyze rhythm; recheck every 2 min
- Attach monitor leads
- Search for and treat possible causes: Hs & Ts
- IV 1-liter NS bolus if hypovolemia suspected (may be chilled)
- Epinephrine 1 mg (10 ml of 1:10,000) IV/IO. Repeat every 3-5 minutes for duration of cardiac arrest
- Consider needle thoracostomy or Sodium bicarbonate 1 mEq/kg IV/IO for pre-existing conditions.
- Consider termination
Given the time sensitive nature of cardiac arrest, treatment is most effective when performed on scene. Unless otherwise noted, transportation to an Emergency Department should be delayed.
Per SB 204, in the setting of hypothermia
- Temperature <30°C or 86°F:
- Continue CPR
- Only administer one round of ACLS drugs
- No more than three defibrillations
- Temperature 30° – 35°C (86° – 95°F):
- Double the interval of time between drug dosing
- Defibrillate normally
Per A105, all EMS personnel may terminate resuscitative efforts
- If resuscitation was started prior to the discovery of an valid DNR as defined in A106, OR
- If, upon further examination, the patient meets the determination of death criteria, including either an injury incompatible with life (i.e. decapitation, or burned beyond recognition) and/or the victim shows signs of rigor mortis (in a warm environment), dependent lividity, or decomposition, OR
- If the following medic conditions below are met
Per A105, medics may terminate resuscitative efforts and not transport patients under active CPR if all of the following exist:
- Good contact between the paramedic unit and the medical control physician
- Successful airway management and medication administration consistent with other protocols in the SW Ohio EMS Protocol
- At least 30 minutes of resuscitative efforts
- NO sustained return of spontaneous circulation at any time (palpable pulse > 60 BPM for at least one five-minute period)
- NO spontaneous respiration, eye opening, motor response, or other neurologic activity at the time stopping resuscitation is contemplated
- The cardiac rhythm is NOT persistent or recurrent VF or VT
- All paramedics and the medical control physician agree with termination of ACLS
- The suspected cause of the cardiac arrest must be something other than hypothermia, electrocution, or lightning strike
It is recommended to transport pregnant patients even if there has been no return of spontaneous circulation, as an unborn fetus may benefit from emergency caesarian-section delivery
Per M418, in the setting of renal failure/ESRD, consider management of hyperkalemia early in resuscitation