As an ACP if I have a patient who arrests, ROSCs and then rearrests, how should I proceed with my epi's after re-arrests? If on scene should I continue until 20 minutes then transport? If on route already should I continue epi's q4 all the way in to the hospital? How about amio/lido in the setting of re-arrests?
- Re-Arrest On Scene:
- Initiate CPR (Cardiopulmonary Resuscitation).
- Administer Epinephrine (Epi) every 4 minutes.
- Administer Lidocaine or Amiodarone as required if not already done while preparing for extrication/transport.
- Perform rhythm checks and defibrillation every two minutes.
- Utilize your clinical judgement and plan for extrication/transport.
- Consider initiating a BHP patch for further consult if needed.
- Re-Arrest Enroute:
- If a re-arrest happens during transport, the first step is to pull over and analyze for a shockable rhythm.
- If you are in close proximity to the hospital, it is advisable to perform a single rhythm analysis and proceed with transport while continuing CPR. Single ACP with no additional resources should prioritize effective CPR over Epinephrine administration.
- If there are multiple rescuers in the vehicle, one provider can perform CPR while the second provider briefly checks for a pulse every 4 minutes to determine if Epi is required. Consider utilizing ETC02 as a diagnostic aid to confirm or rule out ROSC.
- It's important to note that rhythm analysis during transport would not be feasible if transport is chosen after a single analysis due to the hospital's proximity as you will need to pull over for each analysis.
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