Medical Cardiac Arrest | SWORBHP Ask MAC

Category Archives: Medical Cardiac Arrest

May 19, 2023 SWORBHP Category: Medical Cardiac Arrest | Date: May-19-2023

Hello, what are the criteria for identifying hypothermia in a VSA patient? This affects our treatment under ALS PCS 5.1 whether we consider early transport after one analysis. The situation that brought up this discussion was a patient who had been on the floor indoors for a number of days, but still presented with a hypothermic body temperature. If the patient had been found VSA, how would we identify to treat them under the full medical cardiac arrest, or be considered for early transport?

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Medical Cardiac Arrest

May 19, 2023 SWORBHP Category: Medical Cardiac Arrest | Date: May-19-2023

With the new medical cardiac arrest directive I have multiple questions: 1. If a patient re-arrests after getting a ROSC do we A) start the 20mins over? B) analyze once and then carry on to hospital with no further analyzes, or C) complete the remainder of the initial 20mins of CPR? Also does this answer change if the ROSC is at the initial site or in the back of the ambulance? 2. If patient arrests for the 1st time in the back of the ambulance, do you stop for the whole 20mins of CPR, does location of arrest to hospital make a difference? 3. If you have a refractory v-fib and we start early transport to hospital, do we continue to pull over and shock every 2 mins or so we stop shocking while on route to hospital?

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Medical Cardiac Arrest

March 13, 2023 SWORBHP Category: Medical Cardiac Arrest | Date: March-13-2023

Why are we waiting to implement the cardiac arrest medical directive changes until Feb?

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Medical Cardiac Arrest

March 13, 2023 SWORBHP Category: Medical Cardiac Arrest | Date: March-13-2023

For ALS-PCS 5.0: If a patient re-arrested prior to extrication, do we carry out another 20 minutes of resuscitation or do we go after first analysis?

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Medical Cardiac Arrest

October 4, 2022 SWORBHP Category: BLS Patient Care Standards, Medical Cardiac Arrest, Pediatrics | Date: 2022-october-4

Under clinical considerations medical cardiac arrest, plan for extrication and transport after 3 analyses. For Pediatric arrest would we do 3 analyses and go or complete 3 on scene and 4th before departing in ambulance?

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Answer:

Please see the Ask MAC post from March 30, 2022 (see below) that discusses considerations for when to depart scene with a pediatric VSA patient.

To answer your specific question: If you opt to stay on scene for 3 analyses, you are not required to perform a 4^th before departing. Once the third analysis has been completed, priority then becomes expedient transport to hospital. If timing of extrication works out so that it is time for a 4^th analysis when you are preparing to depart, you would be supported in following your resuscitation algorithm, completing an analyses every 2 minutes.

March 30, 2022 Question:

Good day, forgive me if I’m mis-reading this, but CPER digest Oct 2021 just published an info-graphic suggestive of staying on scene to run a complete 4 analyses in the case of a pediatric cardiac arrest with a suspected cause/history which is highly suggestive of hypoxia/respiratory in origin. The rationale that they’re presenting is that you’ve got an arrest where CPR and artificial respirations are our best bet for reversing the cause of the arrest. Any discussion related to this? I believe that our current SWORBHP directives are to depart after 1 analysis for a suspected reversible cause of arrest, (unless the rhythm is shockable). Thanks for any clarification that you can provide.

March 30, 2022 Answer:

The recommendations surrounding pediatric cardiac arrest management in the prehospital setting (early transport versus scene treatment) continues to evolve. Recently, there is some preliminary evidence to suggest that the earlier epinephrine is administered the higher the likelihood of survival. Optimal evidence-based care continues to evolve and the OBHG MAC continues to review evidence and how it relates to all directives within the ALS PCS.

The ALS PCS Cardiac Arrest Medical Directive allows for some clinical judgement when it comes to managing pediatric cardiac arrests. SWORBHP Medical council recommends scene management when it comes to rhythms that are amendable to defibrillation. In cases where defibrillation is not required (hypoxia, sepsis, etc.), paramedics can consider early transport.

This direction allows more paramedic flexibility in assessing each situation. We understand that there are many factors that impact the decision to transport or stay-and-play. Location of call (2 minutes from hospital versus ½ hour), underlying suspected cause of arrest, scope and experience of responders (PCP vs ACP etc). Documentation of your decision-making process is valuable so we can better understand and support your thinking and care when we review these calls.

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June 20, 2022 SWORBHP Category: Medical Cardiac Arrest, Trauma Cardiac Arrest | Date: June-20-2022

So we had a call to a burn victim that was grossly charred, but was breathing. He started to deteriorate in transport but we made it to the hospital. I was wondering if he were to arrest if that would be a traumatic VSA, I know it's not a blunt or penetrating trauma but it doesn't make much sense as a medical cardiac arrest either. Also could a patient meet the standards for an obvious death after patient contact?

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Answer:

This is a very complex case. We will answer your question in two parts.

A trauma is an injury from a physical force, which can include burns. The Advanced Trauma Life Support (ATLS) program states: “burns are a significant type of injury that can occur alone or be coupled with blunt or penetrating trauma.”

A burn in isolation may not seem to meet the indications of the Traumatic Cardiac Arrest Medical Directive and consideration for TOR – “cardiac arrest secondary to blunt or penetrating trauma.” SWORBHP Medical Council would endorse treating burn patients as traumatic injuries and thus be treated under the Trauma Medical Arrest Medical Directive, if applicable. This will result in an early patch consultation which may assist with further direction (continue on scene resuscitation, transport or terminate)

If the patient is initially alive on contact but becomes vital signs absent during care with clinical features consistent with the “obviously dead criteria” of the Deceased Patient Standard, the most pertinent action would be to continue management per the ALS-PCS. As per the Preface of the BLS, “when providing patient care as per the Standards, a paramedic shall ensure that the patient simultaneously receives care in accordance with the Advanced Life Support Patient Care Standards (ALS-PCS)”. In the situation you detail, a patch to the BHP for consideration of Trauma TOR would be recommended.

It is important to remember that all of these cases of traumatic death, and fires will be Coroner’s cases, and involve Fire Marshal investigations. During transport this could result in the ambulance being taken off the road for an extended period of time, and not being able to attend 911 calls. In many cases obtaining a TOR could be challenging as fires can attract hundreds of people to the scene and become very public events with media. It is important to relay the location of the patient and the team’s recommendations when speaking to the BHP so we are best able to support you.

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March 30, 2022 SWORBHP Category: BLS Patient Care Standards, Medical Cardiac Arrest, Do Not Resuscitate (DNR) | Date: March-30-2022

Should I ask for a DNR in every scenario where I may use what's contraindicated? If I were to show up for an unconscious but not VSA female and her husband is on scene and doesn't mention the DNR, should I assume they want treatment and continue with inserting an OPA and bagging if necessary or should I ask for a DNR before starting treatment? Would I get in trouble in this scenario if I treated this patient without the husband saying anything and then once we got to the hospital found out they had a DNR?

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March 30, 2022 SWORBHP Category: Medical Cardiac Arrest | Date: March-30-2022

Hello, I have a question regarding the 4th analysis when you’re actively calling for a medical TOR. If they’re around I’ll speak with family to give them an update on what we’ve been doing, that I’m going to call and doctor and what the outcome of that phone call may be. Often, after I’ve had that chat, and made the call by the time I’m back the 2mins has passed and a 4th analysis may have been done by my partner. What would you like to see happen there. Do we perform that 4th analysis or is that only performed just prior to departure if we’re transporting. Thanks for your help.

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Medical Cardiac Arrest

March 30, 2022 SWORBHP Category: BLS Patient Care Standards, Medical Cardiac Arrest, Pediatrics | Date: March-30-2022

Good day, forgive me if I’m mis-reading this, but CPER digest Oct 2021 just published an info-graphic suggestive of staying on scene to run a complete 4 analyses in the case of a pediatric cardiac arrest with a suspected cause/history which is highly suggestive of hypoxia/respiratory in origin. The rationale that they’re presenting is that you’ve got an arrest where CPR and artificial respirations are our best bet for reversing the cause of the arrest. Any discussion related to this? I believe that our current SWORBHP directives are to depart after 1 analysis for a suspected reversible cause of arrest, (unless the rhythm is shockable). Thanks for any clarification that you can provide.

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January 19, 2022 SWORBHP Category: Medical Cardiac Arrest | Date: 2022-01-19

The AHA and COVID-19 guideline has a caveat that states in "suspected or confirmed COVID-19 cases" we should implement the prescribed practices. In the event that the patient in cardiac arrest is not confirmed or suspected to have COVID-19 symptoms is it reasonable to every to pre-pandemic practice of resuscitation?

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Medical Cardiac Arrest

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