Cardiac Arrest Skills Station

1. Cardiac Arrest Skills Station DYNAMIC CARDIOLOGY IV SKILL STATION 1 IHCC EHS REVIEW

2. Registry Skills Review Compiled and presented by IHCC EHS 2001 paramedic students: • Margaret Lind • StevenRudolph • Karen Thomas

3. Assembles Necessary Supplies • Defibrillator • Airway Adjuncts • Oxygen Supplies • Medications • Monitor Leads • Defibrillator Pads or Conductive Jelly

4. Takes or Verbalizes Infection Control Precautions • Dons Personal Protective Equipment • Verbalizes Appropriate Level of Protection • Takes Necessary Precautions to Avoid Exposure

5. 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

6. Checks Level of Responsiveness • Levels of Responsiveness • Alert • Verbal Stimuli • Painful Stimuli • Unresponsive

7. Checks ABC’s • Airway • Patent • Simple Adjuncts • Breathing • Adequate Rate and Rhythm • Oxygen • Circulation • Gross Bleeding • Pulses Present

8. Initiates CPR- If Appropriate (Verbally) • Pulse and Breathing Absent • Assemble Defibrillator While CPR in progress

9. 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

10. 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

11. 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

12. 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)

13. Appropriately Manages Initial Rhythm • VTach, VFib • Defibrillate with 200J • Asystole • Follow Asystole algorithm • PEA, EMD • Follow PEA algorithm V Fib Sinus Tach

14. Ventricular Fibrillation & Ventricular Tachycardia • ABC’S, 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

15. 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

16. 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

17. Bradycardia (non-arrest) With serious signs and symptoms • 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 Sinus Bradycardia

18. Tachycardia (non-arrest) With serious signs and symptoms • Assess ABC’s • 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 • Lidocaine • Procainamide • Bretylium • Narrow complex • Adenosine • Verapamil • Cardioversion 100 J. Sinus Tachycardia

19. The End