Question: This question is regarding a cardiac arrest from anaphylaxis. If epi is given and the patient has no ROSC, arrest is unwitnessed, and by the 3rd analysis no shock is given, is it acceptable to patch for TOR, or is the TOR contraindicated due to the arrest being of non-cardiac origin?
Answer: This is a great question: thanks for submitting it. The Medical Cardiac Arrest Medical Directive specifies that TOR should be applied to cardiac arrests from a cardiac origin. In previous answers on this forum, we have attempted to simplify for paramedics the distinction that is required between cardiac arrests from a suspected cardiac origin from those of an ashyxial etiology (hanging, drowning, electrocution). We have also suggested this latter group (asphyxial) should be managed as per the Medical Cardiac Arrest Medical Directive rather than the Trauma Cardiac Arrest Medical Directive. We have further supported that these asphyxial type arrests could have a patch to BHP for TOR consideration. Strictly speaking, these asphyxial style arrests (hanging, drowning, electrocution) are not cardiac in origin, and not the types of arrests on which the TOR rules were derived. The rationale for the SWORBHP advocating the patch to the BHP for TOR consideration was to account for the fact that on scene, it is often difficult to determine exactly which types of arrests are from a cardiac etiology. Thus, to simplify the decision making for paramedics on scene in stressful situations, we have supported seeking BHP input for consideration of TOR for both asphyxial and cardiac etiology arrests. Regarding anaphylaxis however, most often these types of arrests are quite obvious: known exposure to allergen, patient covered with rash, significant edema etc…. Given this more evident clinical appearance of anaphylaxis, coupled with the clearly different underlying pathophysiology of the cardiac arrest, we would suggest that the TOR should not be considered or applied to these clearly non cardiac origin cardiac arrests (and as suggested by the Medical Directive itself). Therefore, to answer your question, anaphylaxis: no TOR, follow Medical Cardiac Arrest Medical Directive and transport when directive complete. Great question!