AED / Cardiac Arrest Procedural Overview


These procedures have been developed by the medical staff to reflect standing orders for care of athlete’s experiencing signs and symptoms of sudden cardiac arrest (SCA).  This protocol is a summary drawn from the team’s comprehensive emergency action plan, and is intended to summarize the medical team’s preparation for and initial response to the identified condition.  This protocol summary is intended to serve only as a guideline.  The following procedures are not intended to substitute for prudent autonomous medical decision-making required during actual care and management of a sick or injured individual.  Please see the comprehensive emergency action plan for a formal write-up and reference material.


 

Emergency Management Checklist
BLS SCA Management Supplies ALS SCA Management Considerations SCA Considerations
  • AED
  • BVM ventilator
  • Seal Quick™ resuscitator mask
  • Magill forcepts
  • OPA/NPA
  • Manual suction device
  • Oxygen
  • Non-rebreather mask
  • Heart rate / blood pressure monitor
  • Pulse-oximeter
  • Defibrillator/monitor
  • ECG
  • SGD
  • Laryngoscope
  • ET
  • Stylette
  • Mechanical suction device
  • Airway tube securing device
  • etCO2 monitor
  • ACLS medications
  • Emphasis is always on minimizing interruption of effective compressions, defined by proper rate and depth;
  • Switch compression providers after each cycle of HQ CPR;
  • HQ CPR can be effective provided without removing shoulder pads, but not over the top of shoulder pads;
  • NEVER initiate face mask removal or airway management until effective cardiac care has been initiated;
  • Continue pre-hospital HQ CPR until ROSC or until paramedic or MD calls for transport;
  • Call to transport prior to ROSC generally after 2 rounds of cardiac meds with on-going HQ CPR.

 


Critical Content Overview

The decision to remove protective athletic equipment to provide HQ CPR must be made by qualified health care providers during actual management of a critically injured athlete.  Decisions regarding equipment removal must be made based solely on the medical team’s ability to effectively complete critical care tasks associated with delivery of HQ CPR.  Medical team’s may elect to remove only that equipment that is an immediate impediment to completion of critical care tasks of lifesaving priority. Alternatively, medical teams may prefer full equipment removal as an initial step in the delivery lifesaving critical care.  Which of the previous protocols a team prefers is not as important as the medical team’s conscious decision to undertake appropriate rehearsal and regular training to ensure that completion of critical lifesaving tasks is not delayed or interrupted.

AHA Essential Elements of HQ CPR and Increased Survival
  • Pushing hard and fast to deliver compressions at a depth ≥2 in at a rate of ≥100/min while allowing the chest to fully recoil between compressions;
  • Minimizing interruptions in compressions;
  • Avoid excessive ventilation;
  • Rotate compressions provider every 2 min;
  • If no advanced airway, provide compression-ventilation rate of 30:2;
  • If advanced airway, provide continuous compressions and 1 breath every 6-8 seconds (8-10 breaths/min);
  • Quantitative waveform capnography:If PETCO, <10 mm Hg, attempt to improve quality of CPR;
  • Intra-arterial pressureIf relaxation phase (diastolic) pressure <20 mm Hg, attempt to improve quality of CPR;
  • Defibrillation of VF / pulseless VT:
    • Biphasic: Manufacturer recommendations (eg, initial dose of 120-200 J); if unknown, use maximum available. Second and subsequent doses should be equivalent, and higher dose may be considered;
    • Monophasic: 360 J

 

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