Cardiac Arrest

The pit crew model is a model of lifesaving used in cardiac arrests. It aims to provide the maximum chances of survival for a victim.


When we are treating someone in cardiac arrest we should always attempt to find the cause of the cardiac arrest. To know the 10 treatable causes of cardiac arrest we remember our Hs and Ts.

H's

Hypoxia - low spO2, RR - O2, vents

Hypovolemia - blood loss - control & fluids

Hydrogen ions - acidosis due to hypoxia, DKA, kidney failure, infection - O2, fluids

Hypo/Hyperkalemia - inadequate potassium - calcium gluconate if hyper

Hypothermia - blankets, warmed IV fluids

Hypoglycemia - IV glucose, glucagon

T's

Toxins - naloxone, fluids

Tamponade - blood in pericardium

Tension pneumothorax - build up of air pressure in lung - needle decompression

Thrombosis - heart attack

Thromboembolism - pulmonary embolism

Trauma 

If you regain a normal heartbeat you are now in ROSC. ROSC stands for Return of Spontaneous Circulation. You patient is now alive. Once this happens you must:

  1. Prepare for transfer 
    1. Monitor pulse and heart rhythm
  2. Airway & Breathing
    1. Ensure effective airway; consider support
    2. Maintain spO2 95%+
    3. Continue ventilations if appropriate 
  3. Circulation
    1. Measure BP, aim for SBP >80
  4. Temperature
    1. Measure temperature, allow passive cooling
  5. Blood glucose
    1. Check for hypo/hyperglycemia 
  6. Transport
    1. Transfer directly to the nearest appropriate hospital
    2. Provide ATMISTER alert call

ROLE is Recognition of Life Extinct. This is when a person is legally declared dead. To call someone ROLE they must meet one of these criteria:

  • Massive cranial and cerebral destruction
    • Where injuries are considered by the ambulance clinician to be incompatible w/ life
  • Hemicorporectomy (amputation of the body below the waist, transecting lumbar spine)
    • Where injuries are considered by the ambulance clinician to be incompatible w/ life
  • Massive truncal injury incompatible with life, incl. decapitation
  • Decomposition/putrefaction 
    • Tissue damage suggests pt has been dead for some hours/days
  • Incineration
    • The presence of full-thickness burns charring greater than 95% TBSA
  • Hypostasis
    • Pooling of blood in vessels in the part of the body in the position in which it lies after death. 
  • Rigor mortis

You may also call ROLE when:

  • The presence of a DNR/advance directive 
  • When death is expected due to a terminal illness 
  • Efforts would be futile if ALL of the following exist together:
    • 15 minutes since the onset of the arrest
    • No bystander CPR prior to arrival
    • Asystole for >30 seconds
    • Absence of exclusion factors (see Appendix G)
  • Submersion of adults for longer than 1 hour, children longer than 1.5 hours
    • Submersion, NOT immersion

Resus should continue if there’s a chance they were able to breathe from a pocket of air whilst underwater, or they were showing signs of life upon initial rescue

To confirm ROLE, outside of unequivocal signs, they must have ALL of the following:

  • No ROSC after 20 minutes of ALS
  • No palpable pulses
  • No heart sounds
  • No respiratory sounds
  • Pupils fixed and dilated
  • Asystole >30 seconds

To call a ROLE, in the radio state the time, location and reason, eg:

ROLE at 13:45 on Westgate Road- patient has severe cerebral destruction.


Complete and Continue