asked 5 months ago
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?
1 Answers
answered 5 months ago
  1. Re-Arrest On Scene:
Thank you for your question. In the event of a re-arrest occurring on scene after ROSC (Return of Spontaneous Circulation), the following steps should be followed based on the normal ACLS (Advanced Cardiac Life Support) algorithms:
  • 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.
  1. Re-Arrest Enroute:
In the event of a re-arrest occurring during transport, different considerations come into play. A decision needs to be made whether to pull over and re-initiate resuscitation or provide a single analysis and transport. Here's the approach in such a situation:
  • 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.
By considering these factors, you can make informed decisions regarding resuscitation efforts during transport and ensure the best possible care for the patient.