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.