Ottawa Ems Cardiac Arrest And Rosc Directives

Front 1

Manual Defib for Medical Arrest conditions

Back 1

Over 30 days old
V Fib or pulseless V tach
Altered LOA

Front 2

Manual Defib for Medical Arrest dose

Back 2

Over 8 years old
200j
Q 2 minutes

Front 3

Medical cardiac arrest mandatory patch point

Back 3

Patch to BHP following 3 rounds of epinephrine (or after 3rd analyses if no IV/IO/ETT access). If the BH patch fails, transport to the closest appropriate receiving hospital following the 4th epinephrine administration (or 4th analysis if no IV/IO/ETT access)

Front 4

Medical cardiac arrest transport considerations

Back 4

In unusual circumstances (e.g.: pediatric patients or toxicological overdoses), consider initiating transportation following the first rhythm analysis that does not result in a defibrillation being delivered

Front 5

Epi for Medical cardiac arrest conditions

Back 5

Over 30 days old
Altered LOA
Consider IM route if anaphylaxis
suspected as causative event

Front 6

Epi for Medical cardiac arrest dose for anaphylaxis

Back 6

In the event anaphylaxis is suspected as the causative event of the cardiac arrest, a single dose of 0.01 mg/kg 1:1,000 solution, to a maximum of 0.5 mg IM, may be given prior to obtaining the IV/IO

Front 7

Epi for Medical cardiac arrest dose IV/IO

Back 7

Over 12 years old
Epi 1:10,000
IV/IO
1mg Q 4 minutes. May be rounded to nearest 0.05mg
No max

Front 8

Epi for Medical cardiac arrest dose ETT

Back 8

Over 12 years old
Solution as per BH, ETT
2mg Q 4 minutes. May be rounded to nearest 0.05mg
No max

Front 9

Lido for Medical cardiac arrest conditions

Back 9

Over 30 days old
Altered LOA
V Fib or Pulseless V tach

Front 10

Lido for Medical cardiac arrest dose IV/IO/CVAD

Back 10

Over 12 years old AND over 40kg
1.5mg/kg
Q 4 minutes
Max 2 doses

Front 11

Lido for Medical cardiac arrest dose ETT

Back 11

Over 12 years old AND over 40kg
3mg/kg
Q 4 minutes
Max 2 doses

Front 12

N/S for Medical cardiac arrest conditions

Back 12

Altered LOA
PEA
Any rhythm where hypovolemia is suspected

Front 13

N/S for Medical cardiac arrest contraindications

Back 13

Fluid overload

Front 14

N/S for Medical cardiac arrest dose IV/IO/CVAD

Back 14

Over 12 years old
20ml/kg
Reassess ever 250ml's
Max volume of 2000ml's

Front 15

Med route considerations for Medical cardia arrest

Back 15

The IV and IO routes of medication administration are preferred over the ETT route.
ETT administration may be used if the IV/IO routes are delayed (e.g.: >5 min.)

Front 16

Manual Defib for Trauma/Hypothermia/FBAO Arrest conditions

Back 16

Over 30 days old
Altered LOA
V fib or pulseless V tach

Front 17

Manual Defib for Trauma/Hypothermia/FBAO Arrest dose

Back 17

Over 8 years old
200J shock
1 shock only

Front 18

Manual Defib for FBAO Arrest considerations

Back 18

If the patient is in cardiac arrest following removal of the obstruction, initiate management as a medical cardiac arrest.
If the obstruction cannot be removed, transport following the first analysis

Front 19

FBAO Arrest object removal

Back 19

Utilizing BLS maneuvers and/or laryngoscope and Magill forceps

Front 20

Transport for Hypothermia arrest

Back 20

Transport to the closest appropriate facility without delay following the first analysis

Front 21

Transport for FBAO arrest

Back 21

If the obstruction cannot be removed, transport following the first analysis

Front 22

Mandatory patch point for Trauma arrest

Back 22

Patch to BHP for authorization to apply the Trauma (TOR) Termination of Resuscitation if applicable. If the BH patch fails, transport to the closest appropriate receiving hospital following the first analysis/shock

Front 23

Transport for Trauma arrest

Back 23

If the BH patch fails, or the trauma TOR does not apply, transport to the closest appropriate receiving hospital following the first analysis/shock

Front 24

Trauma TOR for cardiac arrest indications

Back 24

Cardiac arrest secondary to severe blunt or penetrating trauma

Front 25

Trauma TOR for cardiac arrest conditions

Back 25

Over 16 years old Altered LOA
No palpable pulses
No defibrillation delivered AND monitored HR is asystole OR monitored HR >0 AND the closest ER is over 30 min transport time away.

Front 26

Trauma TOR for cardia arrest contraindications

Back 26

Under 16 years old
Shock delivered
Monitored HR is >0 AND the closest ER is less 30 min transport time away.

Front 27

Clinical considerations for Trama cardiac arrest

Back 27

If no obvious external signs of significant blunt trauma, consider medical cardiac arrest and treat according to the appropriate medical cardiac arrest directive.

Front 28

Medical Cardiac arrest steps

Back 28

Assess pt
CPR, Monitor and pads on, Shock if witnessed, 2 min of CPR if unwitnessed, IV in, Epi in Q 4 min, Lido is V tach or V fib Q 4 min max 2 doses, reasses every 2 min, shock if applicable, transport after 3rd Epi or 4th shock/noshock

Front 29

ROSC N/S contraindications

Back 29

Fluid overload
SBP over 90mmhg

Front 30

ROSC N/S dose

Back 30

Over 12 years old
10ml/kg
Reassess every 250ml's
Max volume of 1000ml's

Front 31

ROSC considerations

Back 31

Titrate O2 sat's to over 94%
Avoid hyperventilation and target an ETCO2 of 35‐40 mmHg with continuous waveform capnography

Front 32

ROSC Dopamine contraindications

Back 32

Allergy or sensitivity to dopamine
Tachydysrhythmias excluding sinus tachycardia
Mechanical shock states
Hypovolemia Pheochromocytoma
SBP ≥ 90 mmHg

Front 33

ROSC Dopamine indications

Back 33

Hypotensive

Front 34

ROSC Dopamine dose

Back 34

5mcg/kg/min
Titrate increment of 5mcg/kg/min
Titrate every 5 minutes
Max of 20mcg/kg/min