The  Lee  County  Pit  Crew  Model   First  Arrival  (BLS/ALS)                                                                              

Rescuer  2   • Calls  “Cardiac  Arrest”  on  radio   • Turns  on  AED/Monitor   • Applies  AED  or  monitor  without  interrupting   compressions     • Maintains  open  airway   • Inserts  OPA/NPA     • Apply  high  flow  nasal  cannula  to  patient.   • Takes  over  compressions  

Rescuer  1   • First  to  start  compressions   • Completes  200   compressions  

 

1  

2  

AED/Monitor   Switch  to  transport   agency’s  monitor   when  appropriate  

 

   

The  Lee  County  Pit  Crew  Model                         Rescuer   1     • Immediately  responds  to     patient  and  begins     compressions   • Completes   200  compressions     • High  quality  compressions             1                                     Officer     Resus   • Stays  outside  of  CPR  Triangle     • Completes  Resus  Checklist     • Provides  assistance  as  needed   family  and  collects  patient     • Comforts   information  

 

• Obtain  SAMPLE  History   •  

Rescuer  3   • Prepares  BIAD  with  NG  tube   o ResQPod  &  EtCO2  attached   • Places  BIAD  once  prepared   • Utilizes  mechanical  ventilator   • Available  as  backup  compressor  

3  

Rescuer  2   Calls  “Cardiac  Arrest”  on  radio   Turns  on  AED/Monitor   Applies  AED/Monitor     Performs  200  compressions   during  second  cycle   • High  quality  compressions   • • • •

2  

AED/Monitor   Switch  to  transport   agency’s  monitor   when  appropriate  

IC  

Code  Commander  (IC)  

Must  be  an  ALS  provider   • Attempts  to  stay  outside  of  CPR  Triangle   • Coordinates  2min.  rotations   • Attempts/delegates  vascular  access   • Starts  Resus  Checklist   • Pre-­‐charge  monitor  at  1:45   • Assess  rhythm  at  2  min.  intervals   • Calls  “clear”  and  defibrillates  when   appropriate   • Administer  appropriate  meds  

High  Quality  CPR   ! Limit  interruptions  to  every  two  minutes   o <  10  seconds   o Change  out  compressors   o Assess  rhythm     ! Compression  rate  100  to  120  compressions  per  minute   ! Compression  depth  at  least  2  inches   ! Ensure  full  chest  recoil   ! Utilize  CPR  feedback  on  monitor   ! Immediately  resume  compressions  following  defibrillation   o No  pulse  check   o No  rhythm  check   ! Ventilations   o Apneic  oxygenation  (no  ventilations)  until  airway  device  is  placed   o Utilize  mechanical  ventilator  with  circuit   ! Pulse  Checks   o Only  to  be  performed  during  compressor  switch   o Do  not  stop  compressions  to  assess  pulses   o If  unsure,  resume  compressions      

 

Resus  Checklist     !  “Cardiac  Arrest”  called  

o Hypoxia  

!  CPR  Triangle  Established   !  High  flow  nasal  cannula   !  Code  Commander  Established   !  Continuous  Compressions     ! Monitor  Visible  &  CPR  Feedback  On   ! IV/IO  Access  Established   ! Blind  insertion  airway  device  (BIAD)  

o Hydrogen  Ion   o Hypovolemia   o Hypo/Hyperkalemia   o Hypothermia   o Tablets/Toxins   o Tamponade  (Cardiac)   o Thrombosis  (Cardiac)   o Thrombosis  (Pulmonary)   o Tension  Pneumothorax   ! Vasopressor   ! Antidysrhythmic  

o  ResQPod  (ITD)   o  NG  Tube/Gastric  Decompression   o  EtCO2  (Waveform  Capnography)    

! Fluids   ! Sodium  Bicarbonate  

o Mechanical  ventilator  utilized   o Cervical  collar                        

Termination  of  efforts   ! Prolonged  resuscitation  effort  with  Asystole/PEA  (>  20  min.)   ! Conclusive  signs  of  death  (Rigidity,  Lividity,  etc.)   ! Unable  to  improve  EtCO2  (<  10  mmHg)   ! Trauma  Arrest   ! Efforts  are  futile   ! DNRO  presented  

ROSC  Checklist     !  ResQPod  Off    

ICE  Alert   ! Atraumatic  arrest  

! Scoop  stretcher  

! Unconscious/unresponsive   ! Age  16  or  older  

!  Maintain  BP  (Infuse  30  ml/kg  of  cold  NS)  

! Temp.  >  34  degrees  Celsius  (93.2°  F)     ! Transporting  to  PCI  center    

!  Maintain  HR     !  Transmit  12-­‐Lead  ECG   !  ICE  Alert  (Induced  Hypothermia)   ! Transport  to  PCI  Center  (STEMI  Center)   ! Consider  ET  Intubation  if  unable  to  oxygenate/ventilate     Prior  to  Transport  

Epinephrine  Infusion  

! HR  >  50  bpm  

! 1mg  in  500mL  bag  

! MAP  >  65  mmHg  

! Assure  no  air  in  line  

! ICE  Alert  

! Attach  to  IV  pump  

! Pressor  prepared  

! 1-­‐5  mcg/min  

! Airway  patent  

! 30  mL/hr  =  1mcg/min.  

! 12-­‐lead  transmitted  

! 150  mL/hr  =  5mcg/min  

       

Request  for  Termination  Checklist    

Criteria  to  Terminate   ! Resuscitation  was  performed  

   

o Attempt  was  futile  

 

o DNRO  was  presented   o ROSC  not  achieved    

  Radio  report  to  ER  Physician   ! Initial  presentation   o Witnessed/Unwitnessed  arrest?   o Pre-­‐arrival  CPR?   o Etiology  if  known   o Presenting  rhythm   !  Resuscitative  efforts   o Length  of  resuscitation  effort   o Modalities:  CPR,  airway  established,  IV/IO  obtained   o Medications  administered  &  total  dosages     o Number  of  defibrillations  delivered   !  Patient’s  current  condition   o Presumptive/Conclusive  signs  of  death   o Current  rhythm   o EtCO2  numeric  value          

The  Pit  Crew  Breakdown   First  Stage  (ALS/BLS)   1. Rescuer  1:  Immediately  responds  to  patient’s  right  side  and  begins   compressions.   2. Rescuer  2:  Call  “Cardiac  Arrest”  on  radio.     3. Rescuer  2:  Positions  self  on  patient’s  left  side     4. Rescuer  2:  Turn  on  AED/Monitor  and  place  defib  pads  without  interrupting   chest  compressions.   5. Rescuer  2:  Insert  OPA/NPA  and  apply  high  flow  nasal  cannula.   6. Rescuer  2:    Follows  prompts  (for  AEDs),  or  pre-­‐charges  monitor  at  1:45  (ALS   monitors).   After  200  compressions       7. Rescuer  2:  Clear  patient  &  defibrillate  if  appropriate.     8. Rescuer  2:  Immediately  resume  chest  compressions   Every  two  minutes   • Pre-­‐charge  defibrillator  at  1:45  of  compression  cycle  (or  follow  AED  prompts)   • Switch  compressors   • Analyze  rhythm.       a. If  Asystole/PEA:  immediately  resume  compressions.   b. If  V-­‐fib/V-­‐tach:  Announce  “clear”  one  time  and  defibrillate.    Resume  CPR      

Second  Stage  (4  or  more  rescuers  on  scene)   1. Rescuers  1  &  2:  Continue  high  quality  CPR   2. Rescuer  3:  Insert  BIAD  with  ResQPod  &  NG  tube   Establish  Code  Commander  (Must  be  a  paramedic).   3. Code  Commander:  Establish  the  CPR  Triangle   4. Code  Commander:  Begin  the  Resus  Checklist       Code  Commander  (Paramedic)   • It  is  the  primary  function  of  the  Code  Commander  to  maintain  High  Quality  CPR  and   an  organized  approach  to  resuscitation.   • The  Code  Commander  utilizes  EtCO2  and  the  CPR  feedback  tools  to  assure  high   quality  chest  compressions.   • The  defibrillator  is  to  be  pre-­‐charged  15  seconds  before  the  end  of  compression   cycle.   • During  the  2  min.  marks,  the  Code  Commander  must  assess  the  rhythm.   o If  the  patient  is  in  a  “shockable”  rhythm,  the  Code  Commander  must  clear  the   patient  and  provide  defibrillation.   • The  Code  Commander  should  attempt/delegate  vascular  access  (IO/IV).       • The  Code  Commander  is  responsible  for  the  delivery  of  cardiac  arrest  medications.   • The  Code  Commander  completes  the  ROSC  Checklist  when  appropriate.  

Complete  ROSC  Checklist  prior  to  transport      

Resus  Officer  (EMT  or  Paramedic)   • The  Resus  Officer  will  complete  the  Resus  Checklist.   • The  Resus  Officer  will  collect  patient  demographics,  medical  history,  medication  list,   and  known  patient  allergies.   • It  is  the  responsibility  of  the  Resus  Officer  to  work  with  the  Code  Commander  to   make  sure  all  needs  are  met.   • Resus  Officers  will  communicate  with  the  family  and  friends  of  the  patient  and   provide  any  necessary  comfort.  

 

Lee County Pit Crew - v3.3 -

Blind insertion airway device (BIAD) o ResQPod (ITD) o NG Tube/Gastric Decompression o EtCO2 (Waveform Capnography) o Mechanical ventilator utilized.

313KB Sizes 1 Downloads 115 Views

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