Paramedic Kardex

The is a quick reference ONLY to the Policies and Guidelines set by OCEMSA.
All specific Treatment Guidelines questions should be directed to the OCEMSA Website.
ADULT
Asystole or PEA
Algorithm
New UPDATED 10/1/2021
Initiate an organized approach to CPR with responders in designated positions
PEA / Asystole:
CPR --- 0 minutes
Continue High Quality CPR without interruption unless pulse obtained
Witnessed Arrest - Consider passive ventilation for 6 min.
Un-witnessed Arrest - BVM / ETCO2 or Supraglottic airway unless:
ET indicated (Laryngeal edema from smoke inhalation)
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Continue compression for approx. 2 min., then reassess
Place patient at 30 degrees - Semi-fowler if possible (ACCD)
Apply Automatic Chest Compression device when available before movement
►IV/IO vascular access without interruption of CPR
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PEA / Asystole:
CPR --- 2 minute Reevaluate
Continue High Quality CPR without interruption unless pulse obtained
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PEA / Asystole:
DRUG --- 3 minute Epi #1
Maintain CPR 2 min
►Epinephrine 1 mg IV / IO (0.1 mg /1mL), approximately every 3-5 minutes
Maintain CPR
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PEA / Asystole:
Fluid Bolus --- 3 minute Fluid Bolus
►250 mL NS bolus, may repeat to max of 1 liter to attain and maintain perfusion
→ Correct possible reversible causes:
Hypovolemia, acidosis, hypoxia, tension pneumothorax, hypothermia, toxins
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PEA / Asystole:
CPR --- 4 minute Reevaluate
Evaluate the Patient for shockable rhythms
Continue High Quality CPR without interruption unless pulse obtained
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PEA / Asystole:
CPR --- 6 minute Reevaluate
Evaluate the Patient for shockable rhythms
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PEA / Asystole:
DRUG --- 7 minute Epi #2
Maintain CPR 2 min
►Epinephrine 1 mg IV / IO (0.1 mg /1mL), approximately every 3-5 minutes
Maintain CPR
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PEA / Asystole:
CPR --- 8 minute Reevaluate
Evaluate the Patient for shockable rhythms
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PEA / Asystole:
CPR --- 10 minute Reevaluate
Evaluate the Patient for shockable rhythms
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PEA / Asystole:
INTUBATION --- 11 minute Intubation / Bicarb
►Intubate with minimal interruption of CPR after 10 min of CPR
►Sodium Bicarbonate 50 mL IV / IO
Maintain CPR
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PEA / Asystole:
DRUG --- 12 minute Epi #3
Maintain CPR 2 min
►Epinephrine 1 mg IV / IO (0.1 mg /1mL), approximately every 3-5 minutes
Maintain CPR
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PEA / Asystole:
CPR --- 12 minute Reevaluate
Evaluate the Patient for shockable rhythms
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PEA / Asystole:
CPR --- 14 minute Reevaluate
Evaluate the Patient for shockable rhythms
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PEA / Asystole:
CPR --- 16 minute Reevaluate
Evaluate the Patient for shockable rhythms
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PEA / Asystole:
DRUG --- 17 minute Epi #4
Maintain CPR 2 min
►Epinephrine 1 mg IV / IO (0.1 mg /1mL), approximately every 3-5 minutes
Maintain CPR
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PEA / Asystole:
CPR --- 18 minute Reevaluate
Evaluate the Patient for shockable rhythms
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PEA / Asystole:
CPR --- 20 minute Reevaluate
Evaluate the Patient for shockable rhythms
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Decision Point
1) Remain on scene and continue with treatment (After 30 minutes, choose option 2 or 3)
2) Initiate transport to nearest ERC
3) Base Contact for further orders or pronouncement of patient in the field
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RETURN OF SPONTANEOUS CIRCULATION (ROSC)
If prior to transport the pt develops a rhythm with pulse:
Make BHC for possible transport to Cardiovascular Receiving Center (CVRC)
→ Assess for and correct suspected:
Hypoxia, Hypovolemia, Hypoglycemia, and Hypothermia
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►D10 25 gm/250 mL (10% solution) IVPB / IO
If diabetic and hypoglycemia suspected:
(No D-stick, Non-Traumatic FA)
Epinephrine can be given with D10, there is no negative reaction
Interruption of chest compressions should always be held to a minimum.
Pads can be placed in the antero-lateral and antero-posterior positions;
For implanted pacemaker/defibrillator place pads to either side and not directly on top of the implanted device. For medication patch: remove patch, wipe area clean before attaching an electrode pad.
1:10,000 = 0.1mg/mL
1:1000 = 1mg/mL