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.
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. [U304.Book] Free PDF Forbidden Hunger Lee County Wolves Series Book 1 By Teresa Gabelman. [U304.Book] Free P
In California, the Santa Anna winds can com- ... The Institute of Food and Agricultural Sciences (IFAS) is an Equal Opportunity Institution authorized to provide ...
mandates encourage schools to shift from paper-based to digital education. The. School District of Lee County needed to provide students with technology that.
Mar 22, 2011 - great crew now as I have been in the past. I just want to get out on the water again. Email me with any questions! Thanks for you interest.
PDZ domain-binding activities have been shown for both ad- enovirus type 9 E4 .... primary antibody mouse anti-hDlg (2D11; Santa Cruz Biotechnology, Inc.) was performed ..... ferentiation, while cells that express high-risk HPVs maintain.
Sep 17, 2011 - freighter vying for space on the river dur- ing Friday's practice, nothing was going to stop the St. Mary's crew from putting toughness to the test at ...
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. pit 38 pdf. pit 38 ...
Learning Objective Students will use the Chemistry Reference Table to revisit the tables ... Complete the following in your notebook. Labs/ Tasks I-III ... Diaper Lab what property of organic compounds is related to the material found in diapers?
There was a problem loading more pages. Retrying... the pit ep.pdf. the pit ep.pdf. Open. Extract. Open with. Sign In. Main menu. Displaying the pit ep.pdf.
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Undergrad Pit ...
nausea over my spirit, and I felt every fibre in my frame thrill, as if I had touched the wire of .... trembling convulsively in every fibre. ..... business had I with hope?
... the apps below to open or edit this item. pdf-1446\the-british-service-lee-lee-metford-and-lee-enfield-rifles-carbines-1880-1980-by-ian-d-skennerton.pdf.
Page 1 of 1. multigp-pit-area-sign-bw.pdf. multigp-pit-area-sign-bw.pdf. Open. Extract. Open with. Sign In. Main menu. Displaying multigp-pit-area-sign-bw.pdf.