CH 40 Responding To a Field Code

What is expected during resuscitation for sudden cardiac arrest?

Return of spontaneous circulation

What has improved public response to cardiac arrest?

Training in CPR and availability of Automated External Defibrillators (AEDs)

What are the key components of the Chain of Survival?

Recognition/activation of EMS, immediate high-quality CPR, rapid defibrillation, basic and advanced EMS, ALS and post-arrest care, recovery

What does SMART stand for in developing prehospital program objectives?

Specific, Measurable, Attainable, Realistic, Timely

What is the role of dispatchers in cardiac arrest situations?

To provide hands-only CPR telephone instruction

What should be analyzed by the medical director in cardiac arrest cases?

All cardiac arrests and tapes

What is the importance of community CPR training?

To ensure that CPR is readily available and required for high school graduation

What should be done to ensure AEDs are accessible?

Trained personnel should be at key locations

What is the purpose of simulation training in CPR?

To train for low-frequency, high-risk situations using high-fidelity patient simulators and programmed scenarios

What was emphasized in the ongoing development of CPR guidelines?

The importance of high-quality CPR and immediate initiation of compressions

What is the recommended ventilation rate during CPR?

1 second in duration

What is the consequence of hyperventilation during CPR?

It increases intra-thoracic pressure, compressing the vena cava and decreasing cardiac output

What is the function of the Impedance Threshold Device (ITD)?

To reduce excessive pressure within the chest during CPR

What is the significance of full chest recoil during CPR?

It aids in creating negative intrathoracic pressure, which is important for circulation

What is the recommended compression-to-ventilation ratio in adult CPR?

30 compressions to 2 ventilations

What should bystanders be trained to do during a cardiac arrest?

Quickly initiate CPR and use an AED

What is the advantage of Two-Rescuer CPR?

It facilitates effective chest compressions with less time off the chest

How often should the compressor rotate in Two-Rescuer CPR?

Every 2 minutes

What is the maximum time allowed to determine pulselessness in adult CPR?

10 seconds or less

What should be done if there is no pulse detected?

Begin CPR immediately

What are the common fears that prevent bystanders from performing CPR?

Fear of catching diseases, doing the wrong thing, or inadequate training

What is the recommended action after 2 minutes of CPR?

Check the pulse

What is the role of the EMS director in cardiac arrest cases?

To review all cardiac arrests

What style should reports use in cardiac arrest cases?

Utstein style

What is the importance of practicing with simulated patients?

To ensure code teams are prepared for real-life scenarios

What is the significance of high-quality CPR before defibrillation?

It can double or triple the survival rate in cases of VF or sudden cardiac arrest

What are the age group definitions for resuscitation?

Newly born: first few hours after birth; Neonate: first month after birth; Infant: 1 month to 1 year; Child: 1 year to puberty; Adult: patients with signs of puberty and beyond.

What are common causes for needing CPR in infants and children?

Injury, infections, foreign body in airway, submersion, electrocution, poisoning or drug overdose, sudden infant death syndrome.

What are the pediatric BLS steps?

Responsiveness, Circulation, Airway, Breathing.

What is the CPR technique for infants?

Use the two-thumbs encircling-hands technique.

What does defibrillation do?

Delivers electricity to the heart, used with VF or pulseless VT.

What type of AED should be used for children?

Use an AED with pediatric-size pads and a pediatric dose-attenuator; if unavailable, use an adult AED.

What is the recommended action if you witness a cardiac arrest?

Attach the AED as soon as available and rapidly defibrillate.

What should you do if you did not witness the arrest?

Perform five cycles of CPR, then apply the AED.

What is the goal of good CPR before defibrillation?

To reduce the defibrillation threshold for the patient, increasing the chances of successful defibrillation.

What is the difference in defibrillation for infants and children compared to adults?

Use large adhesive defibrillation pads that fit on a child's chest while maintaining separation.

What should be done after delivering a shock in manual defibrillation?

Immediately begin a 2-minute cycle of compressions.

What are the underlying reversible causes to manage during ongoing CPR?

Hypoxia, hypothermia, hydrogen ions, hypovolemia, hypo/hyperkalemia, toxins, tamponade, thrombus, tension pneumothorax.

What are the two shockable ECG rhythms?

Ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT).

What should be done if a patient is in cardiac arrest for 4 to 5 minutes or longer?

Begin CPR for 5 cycles and then analyze the defibrillator.

What is the typical default setting for manual defibrillation?

The default setting ranges from 120 to 200 joules.

What should be done if the patient wakes up after an effective shock?

Begin compressions immediately.

What is the recommended action to shorten the post-defibrillation interval?

EMS may hold the compressor over (but not touching) the patient's chest.

What is the primary focus during CPR for newborns?

CPR with emphasis on ventilation.

What is the significance of performing CPR before applying an AED?

It can restore oxygen to the heart and increase the chance of successful defibrillation.

What is the recommended action if rhythm converts to VF or pVT after AED attachment?

Perform CPR until the AED is charged.

What is the purpose of defibrillation?

To reset the cardiac cycle and allow the normal conduction system to resume.

What should be done if defibrillation is not useful?

Defibrillation is not useful in asystole or pulseless electrical activity (PEA).

What is the recommended approach if an AED is not available?

Start CPR and prepare an AED to assess for a shockable rhythm.

What is the importance of the first few minutes after cardiac arrest?

The heart is oxygenated and ready for shock; immediate action is crucial.

What should be done after two shocks during manual defibrillation?

Administer epinephrine only after two shocks.

What is the recommended pad placement for infant or child defibrillation?

Either anterior-lateral or anterior-posterior adhesive pad placement is acceptable.

What is the significance of performing CPR for 2 minutes before checking pulse?

It allows for assessment of rhythm and pulse after effective compressions.

What is the recommended duration for effective defibrillation to achieve ROSC?

About a minute.

What should be done immediately when a cardiac arrest is suspected?

Begin compressions immediately.

After performing CPR for how long should you check the pulse and review the rhythm?

After 2 minutes.

What should you do if there is ROSC after CPR?

Stop compressions.

What is the purpose of monitoring the patient's ECG during defibrillation?

To display the patient's heart rhythm.

What should be removed to prevent oxygen flow during shock delivery?

The ventilation device from the advanced airway.

What type of pads should be used for infants during defibrillation?

Pediatric pads and an attenuator.

What should be done if the patient has a hairy chest before defibrillation?

Shave the patient.

What should be done if the patient is wet before delivering a shock?

Move or dry the patient.

How far should you avoid placing defibrillator pads from an AICD or pacemaker?

By a few inches.

What should be done with medication patches before defibrillation?

Remove and wipe the chest dry.

What are the two basic pathways for treatment in the Advanced Cardiac Life Support algorithm?

Shockable rhythms (VF or pVT) and Nonshockable rhythms (asystole or PEA).

What should be done if a patient is in a shockable rhythm?

Administer a single shock and then immediately begin compressions.

What type of drug therapy is included for managing patients in VF or pVT?

Vasopressors, such as epinephrine.

What is the recommended dosage of epinephrine for patients in cardiac arrest?

1 mg IV push every 3 to 5 minutes if pulse is absent.

What antidysrhythmic can be administered after the third shock?

Amiodarone or Lidocaine if amiodarone is unavailable.

What should be considered for patients with torsades de pointes?

Consider magnesium with a loading dose of 1 to 2 g IV or IO.

What is the key point when managing a patient in asystole or PEA?

Consider potential causes and manage appropriately.

What should be done if the patient changes to VF or pVT during management?

Move back to the shockable side of the algorithm.

What is the standard of care for cardiac arrest according to AHA guidelines?

Manual chest compressions.

What does the AutoPulse device do?

Delivers uninterrupted adult compressions.

What is the function of the load-distributing band in CPR?

Squeezes the chest to provide compressions.

What is the purpose of the mechanical chest compression device?

Provides continuous chest compressions and ventilations.

What does the impedance threshold device enhance during CPR?

Enhances chest compressions by creating a vacuum in the chest.

What are the effects of using an impedance threshold device?

Increases cardiac output, blood pressure, and perfusion.

What do AHA guidelines say about the Impedance Threshold Device during CPR?

It is not recommended as an adjunct during conventional CPR and is categorized as Class III: No Benefit.

What is the first step in post-cardiac arrest care?

Manage the airway.

What should be monitored in post-cardiac arrest care?

Respiratory and hemodynamic parameters.

What is the purpose of obtaining a 12-lead ECG after cardiac arrest?

To assess the heart's electrical activity and identify any abnormalities.

What should be done if the patient is comatose after cardiac arrest?

Provide targeted temperature management (TTM), obtain a CT scan of the brain, monitor ECG, and provide critical care management.

What precautions should be taken during cardiac arrest care in a pandemic?

Use PPE before aerosol-generating procedures, limit personnel exposure, and minimize bag-mask ventilation.

When should CPR not be started?

If the patient has obvious signs of death, such as rigor mortis, dependent lividity, putrefaction, or evidence of nonsurvivable injury.

What should be done if there is doubt about starting CPR?

Always start CPR.

What are the conditions under which CPR should be stopped?

When there is return of spontaneous circulation (ROSC), transfer to another provider, inability to continue, a valid DNR order is presented, or reliable criteria indicating irreversible death are present.

What are the rare exceptions for transporting a nontraumatic cardiac arrest patient?

Severe prehospital hypothermia and drug overdose.

What factors should be considered before terminating resuscitative efforts with BLS?

If the arrest was not witnessed, ROSC does not occur after three rounds of CPR and AED analysis, and no AED shocks were delivered.

What should be considered before terminating resuscitative efforts with ALS personnel present?

If the arrest was not witnessed, bystander CPR was not provided, no ROSC after complete ALS care, and no AED shocks were delivered.

What is the role of teamwork in cardiac arrest care?

Teamwork multiplies chances for success.

What are the key steps to success in a code situation?

Know the plays expertly, listen to coaches, have a practice ethic, and use CPR feedback devices.

What are the roles of code team members?

Ventilator, active compressor, on-deck compressor, and other support personnel.

What are the responsibilities of a code team leader?

Perform all skills expertly, back up team members, ensure tasks are completed correctly and on time.

What are some specific responsibilities of a code team leader?

Obtain patient history, interpret ECG, track time and CCF, make medication decisions, delegate tasks, and control the scene.

What should a code team leader do to improve the team?

Help train future leaders and continually improve team performance.

What is the sample plan for a code regarding compressors?

Perform high-quality chest compressions for 2 minutes and assist with mechanical chest compression devices as needed.

What is the role of the ventilator in a code situation?

Ventilate at a ratio of 30:2, suction as needed, and assist with the transition to advanced airway.

What are the responsibilities of the code team leader during a code?

Conduct initial ECG analysis, manage timing, provide IV access, administer vasopressors, and decide on resuscitation termination.

What is the role of the EMS field supervisor in a code?

Bring in mechanical chest compression devices, assist with transitions to mechanical CPR, and contact medical control.