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– AAlert– VVerbal Stimuli– PPainful

Stimuli– UUnresponsive

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, 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)

Appropriately Manages Initial Rhythm

• VTach, VFib– Defibrillate with

200J

• Asystole– Follow Asystole

algorithm

• PEA, EMD– Follow PEA

algorithm

V Fib

Sinus Tach

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

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 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

Bradycardia (non-arrest)• 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

With serious signs and symptoms

Sinus Bradycardia

Tachycardia (non-arrest)• 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

With serious signs and symptoms

The End