Resusitation Decision Alogorithm - C2
Reasons to withhold resusitation
- Injuries incompatible with life e.g. decapitation, massive cranial and cerebral destruction.
- Patient has been deceased for some time evidenced by:
- Rigor mortis
- Dependent lividity
- Tissue decomposition
- Advance care directive
- Person responsible / Doctor request
- Patients> 16 years old with NO cardiopulmonary resuscitation attempt >20 minutes prior to the time of paramedic arrival and time of call
Resusitation Decision Alogorithm - C2
Suspected Reversible Causes
- Hypoxaemia
- Hypovolaemia
- Hypo/hyperthermia
- Hypo/hyperkalaemia
- Thrombosis(cardiac)
- Tension pneumothorax
- Toxins/poisons/drugs
- Tamponade
Resusitation Decision Alogorithm - C2
Mandatory Transport Criteria
- Pregnancy
- Patients ≤16 years old
- Pulmonary embolism
- Anaphylaxis
DYSRHYTHMIAS – TACHYCARDIA C8
Contraindications for cardioversion
- Pts <1 year of age
- ECG indicates Sinus Tachycardia or rapid Atrial Fibrillation
DYSRHYTHMIAS – TACHYCARDIA C8
Treatment Unconscious
≥ 16 years old HR > 160 min
Synchronised cardioversion (to a maximum of 3 shocks)
- 1st shock = 100 joules
- 2nd shock = 150 joules
- 3rd shock = 200 joules
Administer amiodarone if reversion unsuccessful
1- < 16 years old HR ≥ 180 min
Synchronised cardioversion (to a maximum of 3 shocks)
- 1st shock = 1 joules/kg
- 2nd shock = 2 joules/kg
- 3rd shock = 4 joules/kg
Urgent Transport to ED if reversion unsuccessful
DYSRHYTHMIAS – TACHYCARDIA C8
Treatment - conscious, narrow QRS, symptomatic
If conscious with narrow QRS complex (<0.12s) and patient is symptomatic, perform vagal manoeuvre (maximum 2)
DYSRHYTHMIAS – TACHYCARDIA C8
Treatment - conscious, Wide QRS, symptomatic
If conscious with wide QRS complex (≥0.12s) and patient is symptomatic
- Amiodarone – Patients ≥ 16 years of age
- Urgent Transport to ED – Patients < 16 years of age
Urgent Transport indications
A. Unrelieved Upper Airwa Obstruction
Examples include:
- Burns
- Epiglottitis
- Foreign bodies
B. Severe Breathing Problems
Examples include:
- Chest injuries with deterioration
- Severe pulmonary oedema
- Asthma or Chronic Obstructive Pulmonary Disease (COPD) unresponsive to treatment
C. **Severe Circulatory Problems **
Examples include:
- Uncontrollable haemorrhage
- Penetrating trauma (excluding isolated injury to hands and feet)
- Severe shock of any type
- Dysrhythmias with poor perfusion
- Cardiac arrest
- Return of spontaneous circulation following cardiac arrest
- *D. Depressed LOC **
- *If level of consciousness V, P, or U**
- Examples include:
- Head injuries
- Overdose unresponsive to naloxone
- Uncontrolled fitting
**E. Emergency of Other Types **
Examples include:
- Prolapsed umbilical cord
- Severe poisoning
- Uncontrolled severe pain
- Acute coronary syndrome
- Gastrointestinal haemorrhage
- Eye injuries, penetrating or chemical
- Stroke or sudden onset headache or neurological deficit
- Fever with lethargy
- Major trauma
Heart rate for synchronised cardioversion for
patients ≥ 16 years of age
≥160 min
Heart rate for synchronised cardioversion for
patients 1- > 16 years of age
≥180min
The Key Signs of SHOCK
I. Tachypnoea
II. Poor brain perfusion
- Restlessness
- Altered LOC
III. Poor skin perfusion
- Cold
- Pale
- Sweaty
- Capillary refill > 2 seconds
NB: with relative hypovolaemia the skin may be warm and pink
IV. Tachycardia
- ≥ 13 years of age ≥ 100 per minute
- 6 – <13 years of age ≥ 120 per minute
- 1 – <6 years of age ≥ 140 per minute
- < 1 year of age ≥ 160 per minute
V. Hypotension
- ≥ 13 years of age ≤ 90 mmHg systolic
- 6 – <13 years of age ≤ 80 mmHg systolic
- 1 – <6 years of age < 70 mmHg systolic
- <1 year old < 60 mmHg systolic
The BP may be difficult to measure and two useful rules can be used:
- If a radial pulse is palpable the BP is usually >70mmHg systolic
- If only a femoral pulse is palpable the BP is usually between 60 and 70mmHg systolic
Limb Realignment / dificult extrication
sequential proceedure
- Pre oxygenation with continuous high flow oxygen
- Ensure equipment to support ventilation is readily available
- Monitor perfusion status and vital signs (especially respiration rate and level of consciousness)
- Administer Hartmann’s TKVO/ flush medications
- Monitor oxygen saturation with pulse oximeter
Limb Realignment / dificult extrication
Midazolam Contraindications
- Inability to complete steps 1 to 5 of the sequential procedure
- Adequate pain management at rest has not been achieved with an opioid
- Altered LOC for any reason
- <16 years of age
