Cardiac Arrest order?

[18G]

Epi is metabolized pretty rapidly so the effect should be very short lived.

And some ROSC patients require pressor support due to hypotension. In these patients prevention and treatment of hypotension is paramount and are gonna require fluids and pressor support.

 

[usalsfyre]

Epi is metabolized pretty rapidly so the effect should be very short lived.

The problem is we give massive overdoses of it and have no clue how much of it hangs out in the peripheral vasculature prior to ROSC and causes cardio or neurotoxic effects after circulation is restored. I wonder if our results wouldn't be better giving it 100mcgs at a time...

And some ROSC patients require pressor support due to hypotension. In these patients prevention and treatment of hypotension is paramount and are gonna require fluids and pressor support.

Diagnosis is important here in appropriate pressor selection. Epi is a great shotgun choice, unfortunately the default EMS choice seems to be "all dopa all the time".

 

[Shishkabob]

I'm just a bigger fan of Vasopressin due to it's longer duration, and better hemodynamic profile in relation to the organs (IE it shunts pretty much everything but the brain), plus has showed a bigger increase in ROSC when compared to Epi.

If we carried more than just 40u on our trucks, and I actually GOT a EOSC, I'd be calling in pushing for a Vaso drip.

 

[aclsjax]

arrive. CAB. good cpr npa with bvm + defib if needed iv or io. 1st round drugs ( this should take no more than 2 min. then) then think et tube. 2nd round drugs. (et tube is not a must)

 

[MrBrown]

If it is decided an attempt at resuscitation is in the best interest of the patient and clinically appropriate one Ambulance Officer will place an LMA and begin ventilation while the other begins CPR

Cardiac arrest is really quite easy - thump, shock, adrenaline and repeat

We try to get at least three people (four is preferable) to a cardiac arrest.

 

[hyperlyeman1]

I haven't developed a routine (mainly because I'm not a medic yet) but one thing's for sure: Unless they're heartless, brainless, stiff or have some other injury incompatible with life, they get transported no matter what. We don't call a code on the scene. Note that I said that's the protocol, not my preference. If they're dead, they'll be just as dead on their floor as they will at the ER.

But dead bodies at home don't waste space in an ER for a saveable child... IMHO. Work the arrest... my opinion, LOC/ABC's, BLS CPR with BLS airway, Monitor/pads, defib if needed, IV/IO and1st round meds, KING/ETT, if PEA<60 or asystole, call base and cover em.

Again this is in my opinion, if i can't get a viable/shockable rhythm after the first round of drugs and a good ALS airway, they are not going to get transported unless I can find a reversible cause. No reason at all to waste resources on dead people.

I have a close friend who is an ER doctor, if one of the medics I work with brings him a dead patient that should have been called on scene per our protocol, he has been known to go to our QI and have paramedics speak with the QI department. He sits on our protocol board and on the QI board. Thank god for friends in high places ^_^