cardiac arrest tips and tricks you have learned along the way...?
- Thread starter tazman7
- Start date
Also have a question on this code.
Got called for seizure, turned out to be code. When I went to intubate his jaw was clinched very very tight. I had to stick my fingers in his mouth and pry it apart. Guy had esophageal cancer with lots of scar tissue. Very difficult intubation for a newer medic. Iv was unobtainable at that time. Would it be ok to give versed via mad device to relax the pt jaw? It was like he was biting down.. I know he isnt breathing but with spraying it up the nose would it absorb through the mucosal membranes? Or give it im?
Got called for seizure, turned out to be code. When I went to intubate his jaw was clinched very very tight. I had to stick my fingers in his mouth and pry it apart. Guy had esophageal cancer with lots of scar tissue. Very difficult intubation for a newer medic. Iv was unobtainable at that time. Would it be ok to give versed via mad device to relax the pt jaw? It was like he was biting down.. I know he isnt breathing but with spraying it up the nose would it absorb through the mucosal membranes? Or give it im?
Melclin
Forum Deputy Chief
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Don't cut through the defib cables with the trauma sheers. Lol. Didn't do it, but sure came close on my first arrest.
But seriously I'd be really interested in tips too. There must be heaps of stuff that's not in the textbook.
But seriously I'd be really interested in tips too. There must be heaps of stuff that's not in the textbook.
Outbac1
Forum Asst. Chief
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Take your time. The pt is not going anywhere in a hurry. Two min of cpr gives lots of time to set up the defib and start a basic airway, IF the person wanted resusatation.(One of the first questions I ask of bystanders). Get your scene organised. Extra people? Give them a job, move furniture, get stretcher, prepare to take over cpr etc.
I know several who have given versed to try to loosen a trismissed jaw, in seizure pts not arrests. But it didn't work. Drugs tend to need circulation to work and its a fact that dead people have poor circulation.
My 2 cents.
I know several who have given versed to try to loosen a trismissed jaw, in seizure pts not arrests. But it didn't work. Drugs tend to need circulation to work and its a fact that dead people have poor circulation.
My 2 cents.
Epi-do
I see dead people
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Don't be afraid to call for orders to stop CPR if you are getting no response after a reasonable attempt. There is nothing the hospital is going to do in this situation that we cannot do onscene. The cardiac arrest patient isn't going to get any worse, and let's face it, they rarely get better. We need to stop needlessly transporting corpses. Think about it. How many cardiac arrest patients have you taken into the ER that have been worked for more than just a few minutes before the doc calls them? Chances are, very few.
el Murpharino
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Proper training alleviates some of the confusion involved with a code. If everyone knows their position and their role in the care of the patient, it gets rid of that clusterf*ck feeling that seems to find its way into every code. Everyone wants to get their hands in the mix and make an impact on the call....but don't be afraid to tell people to get back...you don't need that many people on a code.
that was the entire problem with this code. to many people in the way. six guys in the back of the ambulance is to much. 3 people working 1 person writing I think would be perfect..maybe even 2:1
akflightmedic
Forum Deputy Chief
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Here is something I always do even with field termination guidelines now.
If the call comes in as unconscious, not breathing, possible cardiac arrest or CPR in progress, I always bring in my long spine board as well.
If I decide to work the patient, me and my partner rapidly place him on the board before we start. This extra 5 seconds at the beginning enables the code to run much smoother for a couple reasons.
First, you do not have to worry about any wires, tubes, or IVs being ripped out or dislodged later on by moving the pt around because you have him on the board BEFORE these interventions are done.
(You still have to reassess these things and yes they can still come out, but the likelihood has been reduced)
Second, when other rescuers arrive, you can move the patient quicker and more efficiently because again you have the board in place. You do not have to wait for someone to bring it in, you do not have to wait to move it under him with special care to all the devices, it is already done.
If the call comes in as unconscious, not breathing, possible cardiac arrest or CPR in progress, I always bring in my long spine board as well.
If I decide to work the patient, me and my partner rapidly place him on the board before we start. This extra 5 seconds at the beginning enables the code to run much smoother for a couple reasons.
First, you do not have to worry about any wires, tubes, or IVs being ripped out or dislodged later on by moving the pt around because you have him on the board BEFORE these interventions are done.
(You still have to reassess these things and yes they can still come out, but the likelihood has been reduced)
Second, when other rescuers arrive, you can move the patient quicker and more efficiently because again you have the board in place. You do not have to wait for someone to bring it in, you do not have to wait to move it under him with special care to all the devices, it is already done.
Why not IO him? Then your access problem is resolved..............
Why would you give him Versed out of curiosity? Why not nasally intubate him or if all else fails go with a failed airway device?
el Murpharino
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Or go with a King-LT, Combitube, LMA....or any other secondary airway device the agency/protocols allow.
I only mention this because we can't nasally intubate in our region...
terrible one
Always wandering
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i thought a contraindiction to nasally intubating was an apenic pt? it was my understanding that they needed spontaneous respirations? or maybe thats just by county/st
if you cant open the jaw how can you can you get an LMA/Combi in?
maybe i read something wrong from the OP
MSDeltaFlt
RRT/NRP
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A dead person's jaw tends to be loose... at least until rigor mortis sets in. If they're apneic with clinched jaws, they're not dead yet. Odds are they're still seizing and not breathing from continuous stimulation of the diaphragm. Nasally tube them. They might still be able to cough, thus facilitating ETI. Even if they're not, you can manipulate trachea externally to help here.
Also, a "code" generally means your pt has no pulse. One does not sedate the dead. Tends to be counter productive.
Some areas, and even services, don't have adult IO. Down here in BFE on the ground truck we don't.
You're not allowed to nasally intubate?!? Wow.
It's not contraindicated. Unless, of course, your protocols say it is. It's just harder.
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If you have capnography capabilities, attach the ETCO2 after you drop the tube, before you attach the BVM for tube confirmation. Along with all other confirmation techniques, good waveform can be the clincher for placement verification. A change in waveform or #'s should alert you to recheck the tube, suction, etc. Check tube placement each and every time the pt is moved. You don't want to have a dislodgement or Rt mainstem displacement for a prolonged time, or at all for that matter. After dropping a tube, placing a C-collar would be a good idea, to help minimize dislodgement potential. If you have a free moment during the arrest, preplan dose calcs for any weight based post arrest drips you may need to admin, if ROSC should occur.
I think continuous capnography monitoring should become the gold standard. My agency has been using it for years and haven't brought in a misplaced tube in a long time.
Or better yet, if you can, just throw them on the stretcher before you start. This works especially well when treating patients in nursing homes or apartment buildings. This also helps if you need to drop a tube. If you can't see the cords, you can drag them back until their head in hanging off the stretcher, which hyper extends the neck.
A reeves also works well.
I'm big on utilizing all the responders on scene. I usually have an emt partner and four firefighters/emts. I make sure that everyone has a job and that I'm always thinking four steps ahead of everyone else. This is easy to do if you have planned in advance. This is important, not just to make the call go smoothly, but for successful outcomes and efficient care. It also allows me to focus on the overall scene more and to make sure every one is doing their job properly. For example, making sure the firefighter isn't bagging at 50 times a min on a closed airway.
So I'll usually have my emt setting up IVs and other equipment. I'll have one FF do bagging, one write down my important observations and medication admin times, the fire Capt. talking to the family and getting the pt's personal info, etc.
This stuff seems like common sense, but believe me, it will make all the difference in pt outcome. Giving people specific jobs also creates a more relaxed atmosphere and prevents people from running around excited and ripping out IVs without getting anything done.
You usually know you've done a good job when arrest calls start to get boring and you find yourself without anything to do while you're waiting for the meds to circulate.
So I'll usually have my emt setting up IVs and other equipment. I'll have one FF do bagging, one write down my important observations and medication admin times, the fire Capt. talking to the family and getting the pt's personal info, etc.
This stuff seems like common sense, but believe me, it will make all the difference in pt outcome. Giving people specific jobs also creates a more relaxed atmosphere and prevents people from running around excited and ripping out IVs without getting anything done.
You usually know you've done a good job when arrest calls start to get boring and you find yourself without anything to do while you're waiting for the meds to circulate.
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Yeah thats what I always thought until this guy.
Just a quick summary on the call.
Called for seizure, half way there were told by other first responders it was full code. UOA they were doing cpr to a witnessed arrest, had aed pads on, already shocked twice. tried twice on a king airway and they pulled it out. our Crew then switched to our pads, pt was in vfib- no pulse, agonal respirations, clinched jaw. shock advised, shock administered. i tried intubating, had to force pt jaw open, couldnt see vocal cords. was told pt had history of esophageal cancer, throat was full of scar tissue. couldnt intubate. so i dropped in a king airway and i had to go to the smallest size we had. got it in and it kept popping out, i literally had to keep my hand on it and hold it down his throat, that wasnt working so we put in an oral airway and bagged, partner got iv started pushed epi, she then tried intubating and couldnt even get his mouth to open. pt then went to asystole on way to ambulance, tried intubating again to no avail. iv got ripped out by fd on way to ambulance, another iv wasnt obtainable. tried 4 times. enroute pt then went into vfib, shocked again, then pea, then vfib, then pea. arrived at hospital with pt in pea. they worked him for 30 minutes. pt was transferred to icu.
An IO was out of the question...our rigs dont have them which is very very dumb. hospital based company doesnt have the funds...
jedirye
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I come from a service where it's a medic and an EMT- that's it. This "pit crew" concept will be helpful for services that roll with fire departments and have several people on scene to assign jobs to beforehand, etc.
Article located Here
Excerpt:
While the CIRC study is a trial, Hillsborough County Fire Rescue has already implemented another procedure. With a nod to NASCAR, the Fire Rescue has started using the “pit crew” approach to emergencies.
As in a race pit crew, each person on a team is assigned specific duties to carry out. The three-person EMS crew follows a pre-defined, standardized process for assessing the scene and starting treatment. Now, crews arrive on the scene and start providing manual or electronic chest compressions, as well as many of the other life saving measures in as little as 45 seconds, a process that previously could have taken a few minutes. This consistency extends to every Fire Rescue crew in the County, and has already improved results with just this new technique of managing the scene.
-rye
Article located Here
Excerpt:
While the CIRC study is a trial, Hillsborough County Fire Rescue has already implemented another procedure. With a nod to NASCAR, the Fire Rescue has started using the “pit crew” approach to emergencies.
As in a race pit crew, each person on a team is assigned specific duties to carry out. The three-person EMS crew follows a pre-defined, standardized process for assessing the scene and starting treatment. Now, crews arrive on the scene and start providing manual or electronic chest compressions, as well as many of the other life saving measures in as little as 45 seconds, a process that previously could have taken a few minutes. This consistency extends to every Fire Rescue crew in the County, and has already improved results with just this new technique of managing the scene.
-rye
reaper
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Sounds like another great FL idea. Let's dumb it down some more!
el Murpharino
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You're right...I was just talking in a general sense, not so much about this particular case. My apologies...