Cardiac Arrest (Asystole/PEA/VF/pVT) - Adult Pearls

What is required about rhythm duration before performing DSED?

Persistent VF/VT without even a transient interruption of the rhythm

What must be true about other treatments before performing DSED?

All other indicated treatment modalities have been implemented

Who must verify the persistence of the arrhythmia before DSED?

A paramedic

What implanted device contraindicates DSED?

A ventricular assist device

What must the paramedic verify about the defibrillators before DSED Part A?

Both cardiac defibrillators/AEDs are attached to the patient and all pads are well-adhered to the skin

Who directs the simultaneous charging of both monitors in DSED?

The paramedic

What should happen once both monitors are charged and all persons are clear during DSED?

The paramedic pushes both shock buttons as synchronously as possible

What should happen immediately after DSED shocks are delivered?

Chest compressions should resume immediately

What should be done if a non-shockable rhythm is present during DSED (Part B)?

Care resumes according to the appropriate protocol

What is the maximum number of DSED shocks that may be applied?

3

What must be ensured throughout the DSED procedure regarding CPR quality?

That the quality of CPR is not compromised

What should be done if two sets of defibrillation pads are not already on the patient for DSED?

Prepare the second site by drying the skin and removing excess hair

What should be removed from the skin before applying a second set of pads for DSED?

Transdermal patches

Where should the second set of DSED pads be placed relative to the first set?

Adjacent to, but not touching, the first pad set

What should be avoided when placing DSED pads?

Placing pads directly over any implanted devices

What is the recommended pad placement configuration for DSED?

Anterior-lateral placement for one set and anterior-posterior placement for the second set

What must be accessible to the paramedic during DSED?

Controls for the second cardiac monitor

Who confirms the rhythm upon rhythm check during DSED?

The paramedic

What H cause of cardiac arrest relates to fluid loss?

Hypovolemia

What H cause of cardiac arrest relates to low oxygen?

Hypoxia

What H cause of cardiac arrest relates to acidosis?

Hydrogen ion (acidosis)

What H cause of cardiac arrest relates to low body temperature?

Hypothermia

What H causes of cardiac arrest relate to potassium levels?

Hypo/Hyperkalemia

What H cause of cardiac arrest relates to low blood glucose?

Hypoglycemia

What T cause of cardiac arrest relates to chest pressure?

Tension pneumothorax

What T cause of cardiac arrest relates to fluid around the heart?

Tamponade; cardiac

What T cause of cardiac arrest relates to poisoning?

Toxins

What T cause of cardiac arrest relates to a pulmonary embolism?

Thrombosis; pulmonary (PE)

What T cause of cardiac arrest relates to a heart attack?

Thrombosis; coronary (AMI)

What temperature defines severe hypothermia in this cardiac arrest protocol?

Core temperature less than 86°F

How many defibrillation attempts are allowed in severe hypothermic cardiac arrest per this protocol?

Only one

What medication may be given in severe hypothermic cardiac arrest per this protocol, and how many repeats?

Epinephrine 1 mg (1:10,000) IVP/IO, no repeat doses

What temperature range defines moderate hypothermia in this cardiac arrest protocol?

86 to 93.2°F

How should medication intervals be adjusted for moderate hypothermia in this cardiac arrest protocol?

Longer intervals between repeated doses

What protocol should be referenced concurrently for cold-exposure cardiac arrest patients?

Hypothermia/Frostbite protocol