three consecutive shocks vs. one and go

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asked 4 weeks ago

Regarding the cardiac arrest protocol, there has been discussion if we come to a scene with one of the indicated reversible causes indicated in our medical cardiac arrest protocol. For example and theoretical; when we arrive at a scene and identify a shockable rhythm, such as pulseless V-tach, the appropriate response is to administer a shock promptly. If, while preparing for transport, the patient reverts to pulseless V-tach, is it advisable that we remain on scene to continue analyzing and shock on the scene to obtained the "three consecutive shocks" and continue to the new directive coming into effect? Or, could we continue to transport with the indications that cardiac arrest is an obvious reversible cause based on clinical judgement?

1 Answers

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answered 1 week ago

Thank you for your question. In patients with shockable rhythms, it would be prudent to stay on scene and continue resuscitation (including defibrillation) until you either achieve ROSC or you have reached 3 defibrillations (or 3 epinephrine doses for ACP). Now that we will be starting Vector Change or Double Sequential External Defibrillation, you may give up to 3 more defibrillations on scene when the scenario calls for it (Refractory shockable rhythm). The load and go criteria for cardiac arrest is based on reversible causes that cannot be addressed prehospital. This would include: patients in cardiac arrest who have a pregnancy greater than 20 weeks gestational age, patients for whom hypothermia might have caused the arrest, patients with an airway obstruction the paramedic cannot clear, and those with a drug overdose for which ED treatments could be beneficial (Beta blockers, Calcium Channel blockers, Digoxin, etc). Importantly, if the paramedic has decided that the patient is salvageable and will benefit from transportation, this can be initiated at the soonest opportunity, once treatments beneficial at the scene are exhausted. There is no requirement to resuscitate on scene for a specific period of time if your interventions are exhausted and you believe transport is indicated. There is also no requirement for a patch in this circumstance. You are welcome to patch to a BHP if you have questions about treatment or the timing of transportation, but if you have no questions and have elected to transport to hospital, please do not spend time patching unless you feel it will benefit you or the patient.