Checklist 3: Transporting a Patient in Cardiac Arrest

Transcription

1 Checklist 3: Transporting a Patient in Cardiac Arrest The procedures surrounding the transport of a patient in cardiac arrest are complex and it is important for Paramedics to understand the impact on patient care prior to choosing a course of action. To assist Paramedics, this review will help to identify some of the history/mechanism considerations, present the sample transport procedure on the Cardiac Arrest Management CD and provide a checklist for your use during practice. History/Mechanism Considerations: 1. Cardiac arrest secondary to an unusual or treatable cause: Patients may have a history that suggests the case is unusual or secondary to a treatable cause requiring prompt transport to hospital. Paramedics should recognise when the cause is unusual or treatable and promptly discuss the best course of action with a physician. Treatable causes of non-traumatic cardiac arrest may include: Hypoxia Hypothermia Hypovolemia secondary to profound non-traumatic haemorrhage Pulmonary embolus Sepsis Pacemaker failure Electrolyte imbalance secondary to renal failure (e.g. dialysis patients) Drug overdose 2. Traumatic Arrests: These patients are in cardiac arrest as a result of traumatic injuries rather than a heart problem. The urgency for these patients to be treated in a hospital is of utmost importance if they are to have any chance at survival. These patients must be transported promptly from the scene without any unnecessary delays enroute to the destination. If the location is appropriate, consideration should be given to the possible utilization of a helicopter or the BCAS Autolaunch procedure for transport. As a general rule, if the mechanism of injury is a minor blunt force trauma suggesting the possibility of a prior cardiac event or commotio cordis begin transport after initial airway support and one no-shock rhythm analysis, continuing to treat as best you can while en-route. CHECKLIST 3 1

2 3. Cardiac Arrests likely caused by a Cardiac problem: Paramedics can have the greatest impact on patient survival by following the BCAS nontraumatic cardiac arrest protocols. The key points are: 1. optimum compression rate 2. optimum depth 3. full chest recoil 4. optimum ventilation volume/rate 5. uninterrupted compressions Keep in mind that methods of delivery may vary from Paramedic to Paramedic, but the emphasis on achieving the key points remains the same. A good example of this is how the Paramedics move around a patient; the method of movement may vary depending on style and the layout of the scene, some Paramedics prefer to shift places, others prefer to move around the patient in a clockwise rotation, and others may have a totally different method. All methods are appropriate if they meet the goal. The goal in the preceding example regarding movement is to move in a professional manner while maintaining high quality patient care. The bigger goal is for all BCAS Paramedics to perform to the BCAS standards in all cardiac arrest management responses. The practice time required by each individual will vary. Be sure to review as frequently as is necessary to ensure that you are able to provide your next cardiac arrest patient with the greatest chance at survival. CHECKLIST 3 2

3 Sample from CD Scenario 2: Transport of a Patient that arrests during transport Patient Attendant Presents with feeling unwell and with a Diabetic history, then suddenly fails to respond during a routine transport to the hospital. Immediately recognises the change in patient status and assesses the patient using the new method A combined LOC/A/B/C check for up to 10 seconds and no more. Patient No response Recognises the patient has agonal respirations, Attendant Notifies the driver Begins the Arrest During Attendance Protocol Safely stops the ambulance in an appropriate location on the road. Notifies Dispatch that the patient is in arrest and states the Driver location. Acknowledges that ALS will respond to that location. Jumps in the back of the ambulance to assist with patient care. Driver and Attendant appropriately treat patient on scene until the ACP crew arrives CHECKLIST 3 3

4 Attendant ACP Crew PCP Crew Provides the ACP crew with a report that includes a brief history, the time in arrest and time treatment (CPR/AED) began and by who the treatment provided I.E number of cycles/shocks if any the patient s response to the treatment if any Continues with appropriate treatment AFTER the first analysis/defibrillation by already applied AED, switch over to manual defibrillator and switch to paddles' lead. Do not stop compressions to assess the underlying rhythm. Assess the rhythm at end of 2 minutes during compressor change. If patient shows signs of life, stop and assess briefly for a pulse. Enter procedures EVENTS on LP12 as provided Assess airway and prepare to then provide intubation without stopping compressions. If unable to intubate, do not attempt repeatedly when effective ventilations can be provided manually. Continually assess compression rate, depth and release. Consider applying the pulse oximeter to patient s finger to gauge compression rates Assist the ACP crew as requested Note: In the event that the patient has ROSC prior to ALS arriving, it would be appropriate to continue to the hospital with notification and attempt to meet the ALS crew enroute. CHECKLIST 3 4

5 Transport Practice Checklist Item or x Confirm the patient should be transported with treatment en route to the receiving facility If possible, identify someone to assist in the back of the ambulance while en route Provide notification to the receiving facility in the MIVT format Continue with treatment while en route Use the ratio 10:1 with continuous compressions and switch compressors every 2 minutes or if alone use the ratio 30:2 and really focus on the quality of your compressions Ask the driver to pull over every 4-5 minutes to allow the AED to effectively analyse. If possible, the driver and attendant should switch roles to provide the compressor with a break. Continue to the hospital in this manner unless a shock is advised, in which case, you would stay on the new scene and follow the usual protocol unless one no shock is obtained then resume transport as per previous. Contact the receiving facility regarding any status changes en route that will result in a change in ETA or a request for new orders. CHECKLIST 3 5