Transcript Dynamic Cardiology Station for Paramedic National Registry

Cardiac Arrest Skills
Station
1
Registry Skills Review
Compiled and presented by
IHCC EHS 2001 paramedic
students:
• Margaret Lind
• Steven Rudolph
• Karen Thomas
Assembles Necessary Supplies
•
•
•
•
•
•
Defibrillator
Airway Adjuncts
Oxygen Supplies
Medications
Monitor Leads
Defibrillator Pads or Conductive
Jelly
Takes or Verbalizes Infection
Control Precautions
• Dons Personal
Protective Equipment
• Verbalizes Appropriate
Level of Protection
• Takes Necessary
Precautions to Avoid
Exposure
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
Checks Level of Responsiveness
• Levels of
Responsiveness
– Alert
– Verbal Stimuli
– Painful
Stimuli
– Unresponsive
Checks ABC’s
• Airway
– Patent
– Simple Adjuncts
• Breathing
– Adequate Rate and
Rhythm
– Oxygen
• Circulation
– Gross Bleeding
– Pulses Present
Initiates CPR- If Appropriate
(Verbally)
• Pulse and Breathing
Absent
• Assemble
Defibrillator While
CPR in progress
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
Cardiac Arrest Skills Station
Dynamic Cardiology
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Correctly interprets initial rhythm
Appropriately manages initial rhythm
Notes change in rhythm
Checks patient condition to include pulse,
Correctly interprets second rhythm
Appropriately manages second rhythm
Notes change in rhythm
Checks patient condition to include pulse,
Correctly interprets third rhythm
Appropriately manages third rhythm
Notes change in rhythm
Checks patient condition to include pulse,
Correctly interprets fourth rhythm
Appropriately manages fourth rhythm
Notes change in rhythm
Checks patient condition to include pulse,
and if appropriate, BP
and if appropriate, BP
and if appropriate, BP
and if appropriate, BP
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
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)
Appropriately Manages Initial
Rhythm
• VTach, VFib
– Defibrillate with 200J
• Asystole
V Fib
– Follow Asystole
algorithm
• PEA, EMD
Sinus Tach
– Follow PEA algorithm
Ventricular Fibrillation &
Ventricular Tachycardia
•
•
•
•
•
•
VFib
•
•
ABC’S, and CPR
Defibrillate up to 3 times, 200 Jules, 200300 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
–
–
–
–
VTach
•
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)
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
Pulseless Electrical Activity
Electromechanical 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
Bradycardia (non-arrest)
With serious signs
and symptoms
Sinus Bradycardia
•
•
•
•
Assess ABC’s
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
Tachycardia (non-arrest)
• Assess ABC’s
With serious signs and
symptoms
•
•
•
•
Attach ECG, pulse
oximeter, blood pressure
cuff
Assess vitals, obtain
patient history
Perform physical exam
If heart rate >150
– Immediate cardioversion
•
If heart rate<150
– Give medications
– Wide complex
Sinus Tachycardia
• Lidocaine
• Procainamide
• Bretylium
– Narrow complex
• Adenosine
• Verapamil
– Cardioversion 100 J.
The End