Cardiac Arrest s & Documentation. Bill Lewis & Ryan Hall

Transcription

1 Cardiac Arrest s & Documentation Bill Lewis & Ryan Hall

2 Content BVM vs. Advanced Airway BLS and ACLS therapy Pregnancy considerations in cardiac arrest/pre-arrest patients Cardiac Arrest documentation issues and avoiding audit responses 1 1

3 BVM vs. ETT The purpose of ventilation during CPR is to maintain adequate oxygenation and sufficient elimination of carbon dioxide There has not been any research done to suggest optimal tidal volume, respiratory rate, and inspired oxygen concentration required to do so 2 2

4 BVM vs. ETT CPR provides approximately 25% to 33% of normal cardiac output Because systemic and, therefore, lung perfusion is substantially reduced during CPR, rescuers can support a normal ventilationperfusion match with a minute ventilation that is much lower than normal 3 3

5 BVM vs. ETT Insertion of an advanced airway may require interruption of chest compressions for many seconds 4 4

6 BVM Techniques Whenever possible, utilize a second rescuer. One rescuer to maintain a tight mask/face seal One rescuer to provide ventilations Pull the victims face toward the mask Maintains head tilt positioning Do not forcefully ventilate Air will go into stomach and cause emptying of contents, compromising the airway 5 5

7 Advanced Airway When is it appropriate to place an advanced airway prior to establishing IV access? Unable to effectively ventilate with BVM Facial hair Anatomy Copious amount of fluid in the airway Blood Vomit Trauma Please ensure documentation in remarks section of ACR to support the decision 6 6

8 CPR The foundation of ACLS care is good BLS care For victims of witnessed VF arrest, prompt bystander CPR and early defibrillation can significantly increase the chance for survival to hospital discharge CPR and early defibrillation are of primary importance, and drug administration is of secondary importance 7 7

9 Cardiac Arrest Few drugs used in the treatment of cardiac arrest are supported by strong evidence After beginning CPR and attempting defibrillation, rescuers can: Establish IV access Consider drug therapy Insert an advanced airway In that order!!! (in most cases ) 8 8

10 Cardiac Arrest Rescuers should provide CPR while the defibrillator charges (when possible) Give the shock as quickly as possible Immediately after shock delivery, resume CPR (beginning with chest compressions) without delay 9 9

11 Cardiac Arrest There is inadequate evidence to identify an optimal number of CPR cycles and defibrillation shocks that should be given before pharmacologic therapy is initiated Resuscitation drugs have not been shown to increase rate of survival to hospital discharge, and none has the impact of early and effective CPR and prompt defibrillation

12 Pregnancy Considerations During attempted resuscitation of a pregnant woman, providers have two potential patients, the mother and the fetus The best hope of fetal survival is maternal survival 11 11

13 Pregnancy Consideration Key interventions to prevent arrest Place the patient in the Left Lateral position Give 100% oxygen Establish IV access and give a fluid bolus (if indicated) Consider reversible causes of cardiac arrest Identify any pre-existing medical conditions that may be complicating the resuscitation 12 12

14 Modifications to BLS At a gestational age of 20 weeks and beyond, the pregnant uterus can press against the inferior vena cava and the aorta, impeding venous return and cardiac output Uterine obstruction of venous return can produce prearrest hypotension or shock and in the critically ill patient may precipitate arrest 13 13

15 Modifications to BLS In cardiac arrest the compromise in venous return and cardiac output by the gravid uterus limits the effectiveness of chest compressions The gravid uterus may be shifted away from the inferior vena cava and the aorta by placing the patient 15 to 30 back from the left lateral position 14 14

16 Modifications to BLS Airway and breathing Circulation Defibrillation 15 15

17 Modifications of ACLS Airway Breathing Circulation 16 16

18 Documentation Issues Drug administration 1 amp Epi Epi 1mg Epi 1: mg Drug Name Concentration (if applicable) Dose (mg) Drug Dose Volume is not dose epi 1: ml Epi 1: mg 17 17

19 Documentation Issues Document O2 use Don t assume that we assume If protocol was altered because of situational or special circumstance, document why Use remarks section 18 18

20 Documentation Issues What is written is what happened Please remember that we were not on the call with you and the only thing we have to go by is what is written on the ACR Most of the ACR audit responses that are sent out could be avoided by more detailed documentation 19 19

21 Documentation Code Procedure Result 200 CPR w O2 & 30:2 Good compressions and Compliance 200 CPR w O2 100 c/min Good compressions and compliance 327 Oral ETT - unsuccessful Unable to visualize vocal cords 345 IV 18 g Lt. AC Patent and Secured ml/hr Infusing Well 351 NaCl Bolus 1400 ml total to be infused 371 NaCl Bolus D/C d 300 ml infused Example only 20 20

22 Summary Early, high quality CPR is the best known treatment in sudden cardiac arrest The best way for a fetus to survive is for the mother to survive Document reasoning if protocol is deviated Clear documentation: It s good for everyone! 21 21

23 Finally If you do not agree with the reason for an audit response or would like clarification on what the response is required for, please contact: 22 22

24 Sources Circulation: The Journal of the American Heart Association. Part 7.1:Adjuncts for Airway Control and Ventilation. Nov. 28, 2005 Circulation: The Journal of the American Heart Association. Part 7.2:Management of Cardiac Arrest. Nov. 28, 2005 Circulation: The Journal of the American Heart Association. Part 10.8:Cardiac Arrest Associated with Pregnancy. Nov. 28, 2005 Michael Callaham MD* and Christopher D Madsen: Relationship of Timeliness of Paramedic Advanced Life Support Interventions to Outcome in Out-of-Hospital Cardiac Arrest Treated by First Responders With Defibrillators: