mechanical CPR should not occur prior to how many minutes?
16 minutes.
Unless there is inadequate resources, access issues, etc.
What are the conditions for which you would transport with Mechanical CPR?
ALL need to be met
- Paramedic witnessed arrest OR presenting with VF/VT
- Likely reversible with medical intervention
- Pt less than of equal to 65 years old and lives independantly
- Alfred hospital < 60 mins from collapse for patients 15-35)
- ECMO or PCI <45 min patients aged 36-65
How many weeks gestation do you need to consider for CPR on preggo ladies?
> 20 weeks
What conditions do you need to consider with preggo’s and cpr?
Aortocaval compression syndrome
aka supine hypertensive syndrome
- compression of inferior vena cava and aorta from uterus
What is the blood flow difference in the uterus when preggs and not?
not = 60ml per minute
Preggo = 600ml per minute
When doing CPR on a preggo, where do you move the foetus?
push over to left hand side
When a patient interferes with CPR or gag reflex becomes present… or patient suspected to be aware what drug should you consider?
ALS: Fentanyl 25mg every 3-5 mins
MICA: Ketamine 20mg
What is the presentation of Fentanyl?
100mcg in 2 mls
or 250 mcg in cartridge
What temperature signals hypothermic cardiac arrest?
<30 degrees c
What is an ECG sign of hypothermic?
Osborne waves
What is an osborne wave?
positive deflection at the J point
In hypothermic cardiac arrest what happens to adrenaline and amiodarone intervals?
double them
How many shocks should you give in hypothermic cardiac arrest and why?
Greater than 3 unlikely to be successful until temperature returns
How many minutes in asystole is generally considered non-survivable?
20 mins
If a patient is asystole what is one thing you should do first?
Check the leads
What are some key questions that need to be asked for cardiac arrest?
- was the arrest witnessed?
- what was the initial rhythm?
- cardiac v non-cardiac causes?
- time to CPR
- Time to defib
- Time to ROSC
What are some compelling reasons to withhold treatment?
- injuries incompatible with life
- rigor mortis
- post mortem lividity
- Putrefaction /decomposition
- Death declared by a doctor
What are the conditions required to determine no prospect of resuscitation>?
Asystole is presenting rhythm
AND
estimated time from collapse to first responder is >10 mins
What are the conditions for ceasing CPR?
PEA/Asystole
- recieved 30 - 45 mins of rescus with no compelling reason to continue
VF
- 45 mins treatment
- no mechanical cpr for transport
- no compelling reason to continue
What are ‘compelling’ reasons to continue cpr?
- signs of life including pupil reaction, agonal or gasping respirations
- periods of ROSC
- youth and or absence of co-morbidities
what are the 6 clinical elements used to determine death - ‘6 determinants of death’?
- no palpable carotid pulse
- No heart sounds for 2 minutes
- No breath sounds for 2 minutes
- Fixed and dilated pupils
- No response to centralised stimulus
- No motor response (withdrawal) or facial grimace to painful stimulus
Can a paramedic verify and certify death?
Can verify, certification must be done by a medical practitioner
What are deaths that need to be notified to police?
- SIDS
- Unnatural or violent death
- death following medical procedure
death of person in custody or care
what are the 3 models for pre-hospital death notification?
- SPIKES
- GRIEV_ING
- 10 Step Model
