cardiac arrest skills station 1. registry skills review compiled and presented by ihcc ehs 2001...
TRANSCRIPT
Cardiac Arrest Skills Station
1
Registry Skills Review
Compiled and presented by
IHCC EHS 2001 paramedic
students:
• Margaret Lind
• Steven Rudolph
• Karen Thomas
Assembles Necessary Supplies
• Defibrillator • Airway Adjuncts• Oxygen Supplies• Medications• Monitor Leads• Defibrillator Pads or
Conductive Jelly
Takes or Verbalizes Infection Control
Precautions• Dons Personal
Protective Equipment• Verbalizes
Appropriate Level of Protection
• Takes Necessary Precautions to Avoid Exposure
Critical Criteria These are actions that will result in automatic
failure of station!• Failure to Verify Rhythm before Delivering Each Shock• Failure to Ensure the Safety of Self and Others (Verbalizes “All
Clear” and Observes)• Inability to Deliver DC Shock (Does Not Use Machine Properly)• Failure to Demonstrate Acceptable Shock Sequence• Failure to Order Initiation or Resumption of CPR when Appropriate• Failure to Order Correct Management of Airway (ET when
Appropriate)• Failure to Order Administration of Appropriate Oxygen at Proper
Times• Failure to Diagnose or Treat 2 or More Rhythms correctly• Orders Administration of an Inappropriate Drug, or Lethal Dosage• Failure to Correctly Diagnose or Adequately Treat V-Fib, V-Tach,
or Asystole
Checks Level of Responsiveness
• Levels of Responsiveness– AAlert– VVerbal Stimuli– PPainful
Stimuli– UUnresponsive
Checks ABC’s• Airway
– Patent– Simple Adjuncts
• Breathing– Adequate Rate and
Rhythm– Oxygen
• Circulation– Gross Bleeding– Pulses Present
Initiates CPR- If Appropriate (Verbally)
• Pulse and Breathing Absent
• Assemble Defibrillator While CPR in progress
Performs “Quick Look” with Paddles
• 1. Turn on EKG monitor• 2. Turn the lead selector to
PADDLES• 3. Apply conductive jelly or use
defibrillation pads• 4. Place paddles firmly on the
bare chest with the paddle marked STERNUM on right chest near sternum, and paddle marked APEX on lower left chest
• 5. Adjust EKG size• 6. Observe scope and determine
patients condition. Check pulse and verify absence of pulse
• 7. If fatal dysrhythmia is noted, proceed with defibrillation algorithm
Cardiac Arrest Skills Station
Dynamic Cardiology• Correctly interprets initial rhythm• Appropriately manages initial rhythm• Notes change in rhythm• Checks patient condition to include pulse, and if appropriate, BP• Correctly interprets second rhythm• Appropriately manages second rhythm• Notes change in rhythm• Checks patient condition to include pulse, and if appropriate, BP• Correctly interprets third rhythm• Appropriately manages third rhythm• Notes change in rhythm• Checks patient condition to include pulse, and if appropriate, BP• Correctly interprets fourth rhythm• Appropriately manages fourth rhythm• Notes change in rhythm• Checks patient condition to include pulse, and if appropriate, BP
Orders high percentages of supplemental oxygen at proper
times• Administer high flow oxygen
– 12-15 LPM per NRB mask, or– 12-15 LPM connected to BVM, or– Positive pressure ventilation
Correctly Interprets Initial Rhythm
• Fatal Dysrhythmias– Ventricular fibrillation (VFib)– Pulseless ventricular
tachycardia (VTach)– Asystole– Pulseless electrical activity
(PEA)– Electromechanical
Dissociation (EMD)– Bradycardia (non-arrest)– Tachycardia (non-arrest)
Appropriately Manages Initial Rhythm
• VTach, VFib– Defibrillate with
200J
• Asystole– Follow Asystole
algorithm
• PEA, EMD– Follow PEA
algorithm
V Fib
Sinus Tach
Ventricular Fibrillation & Ventricular Tachycardia
• ABC’S, and CPR
• Defibrillate up to 3 times, 200 Jules, 200-300 j., 360j.
• If persistent or recurrent VF/VT
• continue CPR, and intubate
• Start IV
• Epinephrine 1mg IV push (repeat every 3-5 min.)
• Defibrillate. 360 J within 30-60 seconds.
• Administer medications of probable benefit– Lidocaine 1.0-1.5mg IV push
– Bretylium 5mg IV push
– Magnesium Sulfate 1-2g IV over 1-2 min
– Procainamide 30 mg/min
• Defibrillate 360 J after each dose of medication (drug- shock, drug- shock)
VFib
VTach
Asystole• Continue CPR• Intubate• Start IV• Confirm Asystole in more
than one lead• Consider possible causes
– Hypoxia– Hyperkalemia– Hypokalemia– Preexisting acidosis– Drug overdose– Hypothermia
• Epinephrine 1mg IV push• Atropine 1mg IV push• Consider termination of
efforts
Pulseless Electrical ActivityElectromechanical
Dissociation• Continue CPR• Intubate• Start IV• Consider possible causes - treatments
– Hypovolemia -Volume infusion– Hypoxia - Ventilation– Cardiac Tamponade - Pericardiocentesis– Tension Pneumothorax - Needle decompression– Hypothermia - See Hypothermia algorithm– Massive pulmonary embolism - surgery, thrombolytics– Drug overdose - Appropriate therapies– Hyperkalemia - Sodium bicarbonate– Massive acute myocardial infarction - See AMI
algorithm
• Epinephrine 1mg IV push• If Bradycardia
– give Atropine 1mg IV push
Bradycardia (non-arrest)• Assess ABC’s• Secure airway• Start IV• Attach ECG, pulse
oximeter, blood pressure cuff
• Assess vitals, get patient history
• Perform physical exam• Interventions
– Atropine 0.5-1mg– Transcutaneous pacing– Dopamine 5-20ug/min– Epinephrine 2-10ug/min
• Prepare for transvenous pacer
With serious signs and symptoms
Sinus Bradycardia
Tachycardia (non-arrest)• Assess ABC’s• Attach ECG, pulse
oximeter, blood pressure cuff
• Assess vitals, obtain patient history
• Perform physical exam• If heart rate >150
– Immediate cardioversion
• If heart rate<150– Give medications– Wide complex
• Lidocaine• Procainamide• Bretylium
– Narrow complex• Adenosine• Verapamil
– Cardioversion 100 J.
Sinus Tachycardia
With serious signs and symptoms
The End