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Spring 2007 CME

Spring 2007 CME. Presented by: SOCPC. Agenda. Presentations: Trauma TOR Changes to Medical Directives High risk obstetrics and neonatal resus Add Ons: Neonatal resuscitation. Termination of Resuscitation for the Trauma Patient. Spring 2007 CME SOCPC. Trauma TOR.

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Spring 2007 CME

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  1. Spring 2007 CME Presented by: SOCPC

  2. Agenda • Presentations: • Trauma TOR • Changes to Medical Directives • High risk obstetrics and neonatal resus • Add Ons: • Neonatal resuscitation

  3. Termination of Resuscitation for the Trauma Patient Spring 2007 CME SOCPC

  4. Trauma TOR • Please refer to the following pages in the medical directives: • PCP Blunt Traumatic Arrest Protocol: Page 47 • ACP Blunt Traumatic Arrest Protocol: Page 48 • Penetrating Traumatic Arrest Protocol: Page 49

  5. Trauma TOR • What is it? • New directive for treatment of VSA trauma patients • Who does it apply to? • Patients who are in cardiac arrest as a result of blunt or penetrating trauma • AED use applies to patients who are ≥ to 8 • PCP- manual mode applies to patients who are ≥ to 1 and < 8 • ACP- manual defibrillation applies to patients of all ages

  6. Trauma TOR • Who can Trauma – Termination of Resuscitation be considered for? • Patients who are ≥ to 16 years old • Patients who are < 16 years old will be resuscitated and transported • What if the patient is obviously dead? • These patients are Code 5 and are not covered under this directive

  7. Blunt Trauma • Procedure: • Confirm absence of spontaneous respirations and palpable pulse in a patient with signs of blunt trauma • Begin CPR • Attach defib pads and assemble airway equipment • Perform analysis or rhythm check

  8. Blunt Trauma • PCP: • Shockable Rhythm: • If the rhythm is shockable deliver one shock • Continue CPR and transport • No further analysis en route • Non-shockable Rhythm: • Check pulse and continue CPR if needed • If there is no pulse AND • Monitor heart rate is > 0, initiate transport • Monitor heart rate is = 0, contact BHP for possible trauma-TOR

  9. Blunt Trauma • ACP: • Shockable Rhythm: • If the rhythm is shockable deliver one shock • Continue CPR and transport • No further defibrillation en route • Asystole or PEA: • Continue CPR • Contact BHP for possible trauma-TOR

  10. Penetrating Trauma • Confirm cardiac arrest • Absence of spontaneous respirations • Absence of palpable pulse • Absence of pupillary response • Absence of movement • Begin CPR • Do not attach defib pads, attach monitoring electrodes

  11. Penetrating Trauma • PCP and ACP: • If monitor heart rate is 0 AND there is no pupillary response AND no spontaneous movement contact BHP for possible Trauma-TOR • If monitor heart rate is > 0 and the emergency department is < 20 minutes away initiate transport • If monitor heart rate is > 0 AND no pupillary response AND no spontaneous movement AND the emergency department is ≥ 20 minutes away contact BHP for possible Trauma-TOR

  12. Penetrating Trauma • In order for a penetrating trauma patient to be considered VSA in addition to the heart rate being 0 the patient also must: • Have no pupillary reaction to light • Must have no spontaneous movements • If the pupils react to light full resuscitation must be attempted and the patient transported

  13. Final Notes • If there are no obvious signs of trauma treat the patient using full medical cardiac arrest directives • PCP’s are expected to contact BHP in these circumstances for possible Trauma-TOR without waiting for ACP’s to arrive

  14. Cardiac Arrest Page: 53 • Cardiac arrests should all be started in AED mode • No drugs administered during 1st 2min round of CPR for VF only • No longer require ETCO2 wave form to confirm intubation (numerical value in AED mode is sufficient)

  15. Neonatal Resuscitation Algorithm Page: 57 • Epinephrine dose has changed to 0.1ml/kg of 1:10,000 IV/IO or 1ml/kg of 1:10,000 ETT

  16. FBAO – Cardiac Arrest Page: 58 • ACPs skip procedure 3 & 4

  17. Return of Spontaneous Circulation Page: 60 • No age restriction • Procedure 6a: • Bolus of 10ml/kg prior to dopamine administration

  18. Zoll “E” Series in AED mode Scenario #1 • Firefighter first-on-scene with chest compressions started a) Direct fire to continue their Zoll AED Pro protocol. b) Prepare your Zoll E-series and airway equipment. If enrolling in ITD protocol attach airway tower to firefighter BVM ASAP c) At the end of the firefighter CPR interval, disconnect pads from their Zoll AED Pro, connect pads into your Zoll E-series and press Analyze. (This will skip pre-programmed upfront CPR on the Zoll E-series and enable the auto-analysis/auto-charge feature.)

  19. Zoll “E” Series in AED mode Scenario #2 • Moving the patient to the ambulance with ongoing CPR a) Disconnect the defibrillation pads. (This will avoid an inadvertent auto-analysis/auto-charge.) b) Reconnect the defibrillation pads in back of unit. c) Press Analyze to do final rhythm analysis before transport. d) Turn Zoll OFF then ON (This will disable the auto-analysis/auto-charge feature.) e) Ignore voice prompts from this point on. f) Transport.

  20. Zoll “E” Series in AED mode Scenario #3 ROSC a) Turn Zoll OFF then ON. (This will disable the auto-analysis/auto-charge feature.) b) Ignore voice prompts from this point on (unless patient re-arrests). b) If needed, disconnect pads temporarily to move patient. c) If patient re-arrests - Press Analyze (This will enable the auto-analysis/auto-charge feature.)

  21. Obstetrics Review Spring 2007 CME SOCPC

  22. Obstetrics Mini-Review • Quick Facts • Normal delivery • Abnormal Presenting Part

  23. Quick Facts • What is the normal gestational period? • What risks do premature babies face? • What risks do post term babies face?

  24. Quick Facts • If the membranes are ruptured what colors in the amniotic fluid would concern you and why?

  25. Quick Facts • What is the average fetal heart rate (FHR) and where is the best place to listen for it? • If the woman is having a contraction and the fetal heart decelerates to 100 or less, is that normal? • If possible, ALL pregnant women should go to a hospital that has what sort of services?

  26. If you saw this what would the steps to take?

  27. Stages of Labour

  28. Breech Presentations Complete Breech Incomplete Breech Frank Breech Abnormal Presentations

  29. What if you saw this?

  30. UNUSUALLY SOHRT UMBILICAL CORD WITH ECCENTRIC POINT OF INSERTION INTO PLACENTA NORMAL UMBILICAL CORD (55cm LONG) WITH CENTRAL INSERTION POINT INTO PLACENTA PLACENTAL ATTACHMENT TO THE UTERINE WALL UTERINE WALL CORD WRAPPED AROUND NECK OF FETUS (NUCHAL) CERVIX Nuchal Cord

  31. Prolapsed cord

  32. Questions?

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