59 year old male, cardiac arrest

[Arctickat]

Triemal;

The ambulances met on the side of the road, no turnout is available. Both ambulances are the same size, just the cot mounts don't match up.

[paramedicmike]

PEA at 10? Continue compressions and give another round of EPI.

[Arctickat]

Epi is given and a perfusing heart rate of 130 - 140 soon appears with a BP of 128/67, Sp0₂ is 94 and climbing with BVM and an OPA.

Edited September 14, 2013 by Arctickat

[BushyFromOz]

ECG / 12ld, GCS, temp + full set of vital signs

Get them on my kmonitor

Prepare for RSI and cooling

Adrenaline infusion drawn up in case she bottoms out again.

[Arctickat]

GCS is 3, 12 lead is attached Vitals:

BP 132/70

HR 140

RR no respiratory effort, BVM and OPA 12 per minute

SpO₂ 96%

Skin, warm, pink, dry

Pupils, Right ERL, Left Non reactive.

Edited September 14, 2013 by Arctickat

[J306]

Establish a second line, get a glucose reading off of the IV stick, check lung sounds for any signs of aspiration or flash pulmonary edema. With no respiratory effort, intubation could be considered.

[Arctickat]

Second line is in, BGL is 22.8 mmol/L, Lung sounds are good, Vitals are still good, with the exception of no respiratory effort, Would you like to intubate?

[J306]

Set second line to TKO to be sure not to fluid overload, reassess pupils, Glucose spike could be due to stress response. I would like to have this pt. intubated, however, under the new MFI protocol, I'd like to call med control first for orders to maintain sedation if needed, 25-50 mcg fentanyl PRN, and lets hook the tube up to your portable ventilator that you have in your ALS unit for the trip to the hospital.

[Arctickat]

Why would you need to sedate him with a GCS of 3? You don't need medical control to intubate an apneic patient.

Edit:

Pupils remain the same

Edited September 14, 2013 by Arctickat

[BushyFromOz]

Why would you need to sedate him with a GCS of 3?

I dont get a choice if inducing hypothermia for ROSC management

Whats the patient weight?

100mcg Fentanyl

.1 mg/kg midazolam

1.5mk/kg suxemethonium

Tube

8mg pancuronium

morph/midaz infusion, start off low at 1mg/hr

upto 2L ice cold saline, aim for temp of less than 34C

Edit. I dont do this stuff yet, just trying to get into the spirit of things =D

Edited September 14, 2013 by BushyFromOz