Category Archives: Medical Cardiac Arrest

Question: I was looking through Ask MAC and there are a few questions pertaining to cardiac arrest and shocks or no shocks of other responders. Are Paramedics are to include shocks delivered by the Fire Department prior to arrival in their treatment of a VSA patient?

My understanding from teachings in 2014/2015 is that if Fire delivered shocks we could count what they did. If they did not, we did not count their no shocks and conducted our own working towards the medical TOR which is also covered in the Summary of Changes document.

The question on ASK MAC seems to say if we trust the responders we can count everything I was hoping for a clarification that can be searched when the question comes up again.

Question: With respect to the updated July 17, 2017 medical directive changes, are hangings, electrocution and anaphylactic cardiac arrests considered reversible causes of arrest, and therefore subject to consideration for early transport after 1 analysis, OR are they to be run as full medical cardiac arrests/4 analyses, regardless of whether defibrillation is indicated? Thank you.

Question: When running an ALS arrest where the patient is showing a PEA on the monitor with an accompanying high ETCO2, could we assume that this patient is in fact perfusing to some degree and pulses are just not palpable for various reasons (obesity, severe hypotension, etc.)?

Secondly, if the above assumption is correct, would it be prudent to stop CPR provided the ETCO2 remains high and administer Dopamine in hopes of increasing BP until pulses are palpable and BP obtainable; or should the vasopressor effects of Epinephrine be sufficient to facilitate this so just continue with Epinephrine q5 min and CPR?

Question: After consistent review of the new ALS, I just came across something that I am hoping you may clarify for me. In regards to the Medical Cardiac Arrest directive, under the "clinical considerations," it states that under certain circumstances we transport after first rhythm analysis (and lists some examples). In the old ALS, one of these examples was "pediatrics" but now i notice that in the new ALS, also under clinical considerations, it mentions to plan for extrication and transport of pediatric cardiac arrest patients after 3 analyses. So, does this mean we do not transport after first rhythm analysis for pediatrics and must complete the full directive now?

Question: CPR guidelines: I understand that we start CPR with a patient less than 16 years old, heart rate less than 60 and signs of poor perfusion, agonal respirations as per the CPR guidelines. My question is if we have the same situation with an adult patient, what would be beneficial for this type of patient (CPR)?

Question: How many analyses would you perform on a patient who is VSA following a drowning. Is it considered special circumstances, should the patient be transported after one analysis? Or should we transport after the first rhythm that doesn't result in a defibrillation? How many shocks total if patient stays in a shockable rhythm (4 max or more)?

Question: As per the question posted Feb 5th, 2014, if the FD shocks a patient prior to our arrival, we may count that shock into our protocol assuming we deem their care to adhere to AHA guidelines. In that setting, do we dial up to our second shock dose, or start at our first shock dose and dial up appropriately after that?

Question: After the recent introduction of Narcan for PCPs, I'm still a little confused about the role of Narcan in an arrest. The 2010 AHA Guidelines state there is no role for Naloxone in cardiac arrest but the 2015 Guidelines are less prohibitive, leaving some room for interpretation. I understand that where there is question whether the patient is pulseless or not, there is a role for naloxone in the setting of presumed opioid overdose but what is the direction of base hospital for the use of naloxone where there is definite absence of vital signs in the setting of a PCP-only arrest. Is it the expectation of the base hospital that PCPs attempt to administer naloxone at some point during that call? If so, when during the cardiac arrest protocol? On scene or en route to hospital?

Question: If a pediatric patient is significantly larger than expected (for example, a 6 year old female who weighs 120lbs), do we still use the pediatric dosing chart OR calculation OR adult settings? Personally, if I'd done this call today, I probably would have chosen to use the pediatric calculations of 2J/kg then 4J/kg etc.

i.e.: If using peds dosing chart, this 6 year old would only get a shock of 50J 100J 100J 100J

i.e.: If using peds calculation, she would receive 110J 220J 220J 220J

i.e.: If using adult settings, she would receive 200J 300J 360J 360J

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