About
Section 1: General Patient Care
Section 2: Medical Protocols
Section 3: Cardiac Emergencies
Section 4: Trauma Protocols
Section 5: Airway Protocols & Procedures
Section 6: Medical Director Options
Section 7: Medical Policies & Procedures
Section 8: Special Operations Principles
Appendices
1.01 - High Quality CPR
Note:
Only for arrests of Cardiac etiology.
For primary respiratory etiology, ventilate immediately as part of CPR.
For primary respiratory etiology, ventilate immediately as part of CPR.
Note:
- Perform 2 minutes cycles of uninterrupted chest compressions
- Interrupt chest compressions only after each 2 minute cycle
- Follow current AHA/ILCOR recommendations for cardiac arrest management.
EMT-Basic (Standing Orders)
- 1.0 - Routine Patient Care- with focus on high quality CPR
- Immediate chest compressions at a rate of 100-120 per minute
- Use AED as soon as possible with minimal interruption of chest compressions
- Continue 2 minute cycles of uninterrupted chest compressions followed by AED analysis and shock for 4 cycles (first 8 MINUTES)
- Place an oral or nasal airway
- Ventilation / oxygenation options during 4 cycles (8 minutes):
- BVM ventilation during recoil and without interrupting compressions OR
- If part of a care bundle, apply high flow oxygen via NRB
- Ventilation / oxygenation options after 4 cycles (after 8 MINUTES):
- Continue 2 minute cycles of uninterrupted chest compressions.
- If passive insufflation was used, switch to BVM ventilation.
EMT-Advanced (Standing Orders)
- Consider placement of a supraglottic airway device.
- Place IV/IO without interrupting chest compressions.
EMT-Paramedic (Standing Orders)
- If utilizing a BVM, monitor quantitative waveform capnography throughout resuscitation to assess CPR quality and to monitor for signs of return of spontaneous circulation (ROSC)
- Provide manual defibrillation as indicated after each 2 minute cycle
- After 4 cycles (8 minutes):
- Consider endotracheal intubation or use an alternative airway without interrupting chest compressions
- If authorized and trained by AHMD, Paramedics may use mechanical ventilators in rate control mode with the following settings:
- Rate of 8-12 breaths per minute
- Tidal volume 300-500mL
- Start at FiO2 1.0 (100%) then titrate to maintain SpO2 > 94% (90% for COPD patients)
- Relief pressure 45-60 cmH2O
- Paramedics may utilize mechanical ventilator following the initiation of respiratory component at least 8 minutes after start of resuscitation even if ROSC has occurred.
Note:
PEARLS:
- It is expected, unless special circumstances are present, initial 8 minutes of resuscitation will be performed on scene.
- Early CPR and defibrillation are the most effective therapies for cardiac arrest care.
- Minimize interruptions in chest compression, as pauses rapidly return the blood pressure to zero and stop perfusion to the heart and brain.
- Recognizing the goal of immediate uninterrupted chest compressions, consider delaying application of mechanical CPR devices until after the first four cycles (8 minutes). If applied during the first 4 cycles, the goal is to limit interruptions. Mechanical devices should only be used by services that are practiced and skilled at their application.
- Switch compressors at least every two minutes to minimize fatigue.
- Perform chest compressions while defibrillator is charging and resume compressions immediately after the shock is delivered.