Dynamic Cardiology Station for Paramedic National Registry

Transcript Dynamic Cardiology Station for Paramedic National Registry

Cardiac Arrest Skills Station

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 – A lert – V erbal Stimuli – P ainful Stimuli – U nresponsive

Checks ABC’s

• A irway – Patent – Simple Adjuncts • B reathing – Adequate Rate and Rhythm – Oxygen • C irculation – 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, 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

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)

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

VFib

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.

VTach 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)

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)