Cardiac Arrest Skills Station

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Cardiac Arrest Skills Station
DYNAMIC CARDIOLOGY
IV SKILL STATION
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IHCC EHS
REVIEW
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Registry Skills Review

• Compiled and presented by
• IHCC EHS 2001 paramedic
• students
• Margaret Lind
• Steven Rudolph
• Karen Thomas

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Assembles Necessary Supplies

• Defibrillator
• Airway Adjuncts
• Oxygen Supplies
• Medications
• Monitor Leads
• Defibrillator Pads or Conductive Jelly

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Takes or Verbalizes Infection Control Precautions

• Dons Personal Protective Equipment
• Verbalizes Appropriate Level of Protection
• Takes Necessary Precautions to Avoid Exposure

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Critical Criteria

• These are actions that will result in automatic
  failure of station!
• Failure to Verify Rhythm before Delivering Each
  Shock
• Failure to Ensure the Safety of Self and Others
  (Verbalizes All Clear and Observes)
• Inability to Deliver DC Shock (Does Not Use
  Machine Properly)
• Failure to Demonstrate Acceptable Shock Sequence
• Failure to Order Initiation or Resumption of CPR
  when Appropriate
• Failure to Order Correct Management of Airway (ET
  when Appropriate)
• Failure to Order Administration of Appropriate
  Oxygen at Proper Times
• Failure to Diagnose or Treat 2 or More Rhythms
  correctly
• Orders Administration of an Inappropriate Drug,
  or Lethal Dosage
• Failure to Correctly Diagnose or Adequately Treat
  V-Fib, V-Tach, or Asystole

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Checks Level of Responsiveness

• Levels of Responsiveness
• Alert
• Verbal Stimuli
• Painful Stimuli
• Unresponsive

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Checks ABCs

• Airway
• Patent
• Simple Adjuncts
• Breathing
• Adequate Rate and Rhythm
• Oxygen
• Circulation
• Gross Bleeding
• Pulses Present

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Initiates CPR- If Appropriate (Verbally)

• Pulse and Breathing Absent
• Assemble Defibrillator While CPR in progress

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Performs Quick Look with Paddles

• 1. Turn on EKG monitor
• 2. Turn the lead selector to PADDLES
• 3. Apply conductive jelly or use defibrillation
  pads
• 4. Place paddles firmly on the bare chest with
  the paddle marked STERNUM on right chest near
  sternum, and paddle marked APEX on lower left
  chest
• 5. Adjust EKG size
• 6. Observe scope and determine patients
  condition. Check pulse and verify absence of
  pulse
• 7. If fatal dysrhythmia is noted, proceed with
  defibrillation algorithm

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Cardiac Arrest Skills StationDynamic Cardiology

• Correctly interprets initial rhythm
• Appropriately manages initial rhythm
• Notes change in rhythm
• Checks patient condition to include pulse, and if
  appropriate, BP
• Correctly interprets second rhythm
• Appropriately manages second rhythm
• Notes change in rhythm
• Checks patient condition to include pulse, and if
  appropriate, BP
• Correctly interprets third rhythm
• Appropriately manages third rhythm
• Notes change in rhythm
• Checks patient condition to include pulse, and if
  appropriate, BP
• Correctly interprets fourth rhythm
• Appropriately manages fourth rhythm
• Notes change in rhythm
• Checks patient condition to include pulse, and if
  appropriate, BP

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Orders high percentages of supplemental oxygen at
proper times

• Administer high flow oxygen
• 12-15 LPM per NRB mask, or
• 12-15 LPM connected to BVM, or
• Positive pressure ventilation

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Correctly Interprets Initial Rhythm

• Fatal Dysrhythmias
• Ventricular fibrillation (VFib)
• Pulseless ventricular tachycardia (VTach)
• Asystole
• Pulseless electrical activity (PEA)
• Electromechanical Dissociation (EMD)
• Bradycardia (non-arrest)
• Tachycardia (non-arrest)

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Appropriately Manages Initial Rhythm

• VTach, VFib
• Defibrillate with 200J
• Asystole
• Follow Asystole algorithm
• PEA, EMD
• Follow PEA algorithm

V Fib
Sinus Tach
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Ventricular Fibrillation Ventricular Tachycardia

• ABCS, and CPR
• Defibrillate up to 3 times, 200 Jules, 200-300
  j., 360j.
• If persistent or recurrent VF/VT
• continue CPR, and intubate
• Start IV
• Epinephrine 1mg IV push (repeat every 3-5 min.)
• Defibrillate. 360 J within 30-60 seconds.
• Administer medications of probable benefit
• Lidocaine 1.0-1.5mg IV push
• Bretylium 5mg IV push
• Magnesium Sulfate 1-2g IV over 1-2 min
• Procainamide 30 mg/min
• Defibrillate 360 J after each dose of medication
  (drug- shock, drug- shock)

VFib
VTach
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Asystole

• Continue CPR
• Intubate
• Start IV
• Confirm Asystole in more than one lead
• Consider possible causes
• Hypoxia
• Hyperkalemia
• Hypokalemia
• Preexisting acidosis
• Drug overdose
• Hypothermia
• Epinephrine 1mg IV push
• Atropine 1mg IV push
• Consider termination of efforts

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Pulseless Electrical ActivityElectromechanical
Dissociation

• Continue CPR
• Intubate
• Start IV
• Consider possible causes - treatments
• Hypovolemia -Volume infusion
• Hypoxia - Ventilation
• Cardiac Tamponade - Pericardiocentesis
• Tension Pneumothorax - Needle decompression
• Hypothermia - See Hypothermia algorithm
• Massive pulmonary embolism - surgery,
  thrombolytics
• Drug overdose - Appropriate therapies
• Hyperkalemia - Sodium bicarbonate
• Massive acute myocardial infarction - See AMI
  algorithm
• Epinephrine 1mg IV push
• If Bradycardia
• give Atropine 1mg IV push

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Bradycardia (non-arrest)

• Assess ABCs
• Secure airway
• Start IV
• Attach ECG, pulse oximeter, blood pressure cuff
• Assess vitals, get patient history
• Perform physical exam
• Interventions
• Atropine 0.5-1mg
• Transcutaneous pacing
• Dopamine 5-20ug/min
• Epinephrine 2-10ug/min
• Prepare for transvenous pacer

With serious signs and symptoms
Sinus Bradycardia
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Tachycardia (non-arrest)

• Assess ABCs
• Attach ECG, pulse oximeter, blood pressure cuff
• Assess vitals, obtain patient history
• Perform physical exam
• If heart rate gt150
• Immediate cardioversion
• If heart ratelt150
• Give medications
• Wide complex
• Lidocaine
• Procainamide
• Bretylium
• Narrow complex
• Adenosine
• Verapamil
• Cardioversion 100 J.

With serious signs and symptoms
Sinus Tachycardia
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The End