Category Archives: Return of Spontaneous Circulation

Question: You have a patient who you obtain ROSC and return of spontaneous respiration on scene who was in a VF (post rosc 12lead shows STEMI). They arrest on route into a VF, we pull over, defibrillate. You resume transport and reassess after each cycle of CPR. If you obtain ROSC again during transport, and the patient rearrests for a second time, is it prudent to pause transport quickly again for defibrillation. The treatment for VF is defibrillation. If there is still prolonged transport the pt will likely deteriorate to asystole if not defibrillated, correct? I appreciate we do not want to delay definitive care, would it be helpful or harmful to continue defibrillation in this setting.

Question: You respond to a call for a 57 year old male patient who collapsed while cutting the lawn. On arrival, his neighbour who witnessed the arrest, reports that she saw him fall and when she checked on him, she realized that he was in cardiac arrest and started CPR. You confirm that the patient is VSA and quickly apply the defib pads. You deliver one shock and start CPR again but the patient begins to moan and tries to raise his arms. Your next action would be to...?

Question: In the ROSC protocol I do not notice an age range specified. If we have a patient 0-2 years old that has a ROSC, can we bolus? Thank you.

Question: When arriving at a scene that turns out to be a ROSC, say Fire applied two shocks and now patient is alert and oriented, and fire pads are not compatible. Do we apply monitor electrodes, defib pads or choose based on our gut of how unstable the patient looks and might re-arrest? Having chosen and justified on the remarks section, what would you like to read to feel we were justified?

Question: This question is similar to one already answered but slightly different. If you have a VSA patient as a result of a FBAO and the obstruction is relieved, should you analyze right away or continue with a 2 minute block of CPR. Also, after having done the medical defib protocol does this patient now qualify for a Medical TOR?

Question: I have a few questions about some of the omissions from these protocols that were in the old protocols. The first one is in the event chest pain resolves and re-occurs it is treated as a new episode and nitro protocol repeated. This isn't stated in the new protocol so if this were to occur can we repeat although it isn't stated? The other question is regarding the medical arrest protocol. No provision is made in regards to on scene ROSC and re-arresting patient in ambulance. The old protocol says we can pull over and analyze once then continue to receiving facility. With nothing in the new protocol do we follow the same format? Thank you.

Question: On our ROSC protocol, the ONLY route that we are allowed to give a fluid bolus/dopamine is via an IV. Please confirm that we are NOT allowed to do so via IO or CVAD? This does vary from the IV and Fluid Therapy protocol which allows us to do so.

Question: Would bolusing a hypothermic ROSC be considered active rewarming?