Cardiac / ResuscitationCritical Care and Paramedic Levels

Chest Pain—ACS

• Replaces “Chest Pain” protocol

• More focused on cardiac chest pain

• Early EKG • Cardiac equivalents– Shortness of breath,

epigastric pain, nausea, altered mental status, weakness

STEMI

• NEW PROTOCOL• Contact Medical

Direction prior to transport– Destination decision– Possible helicopter

transport• Chest Pain Checklist

Symptomatic Bradycardia

• Changes:– Treatment based on

symptoms only– Sedation option if

pacing– Glucagon now in

“Overdose” protocol

Tachycardia with a Pulse

• Changes:– Treatment options more

symptoms based• Still requires some

interpretation of rhythm

– Sedation option– Early EKG

Cardiac Arrest—Initial Care

• NEW PROTOCOL• References rhythm

based protocols• Reinforces BLS– Good CPR– Intubation not required

if ventilation adequate– Consider supraglottic

airway

VF/Pulseless VT

• Changes:– Reinforces good CPR– Discourages transport

unless ROSC– Field termination

allowed and encouraged if unsuccessful after 20 minutes of ALS and poor EtCO2

PEA/Asystole

• Changes:– Combines previous

protocols– NO MORE Atropine– Again, discourages

automatically transporting unless ROSC achieved

Post Cardiac Arrest

• Changes:– More encompassing

than just Therapeutic Hypothermia• ASA administration• EKG acquisition

Pediatric Cardiac Arrest

• General Approach• Intubation is

deemphasized• Understand

Termination Rules

Pediatric Cardiac Arrest

• Intubation Deemphasized

• Epi, Epi, Epi!

Peds: Bradycardia

• Epinephrine preferred over Atropine

Peds: Tachycardia

Neonatal Resuscitation