Welcome to the CPR/AED re-certification for 2020

Objectives

The objective of this refresher training is to provide personnel with material that meets the annual re-certification requirements for MIEMSS EMT/ALS certifications and/or licenses.

The material in this presentation must be reviewed in its entirety prior to demonstrating the following skills with a CPR Instructor: Adult 1 & 2 Rescuer CPR; use of AED, BVM, and Lucas. The skills may be accomplished using the "Pit Crew" model as long as providers rotate through all positions during scenarios. All providers must play the initial responder role, performing the initial assessment at least once. Supervisors must document skill verification via MCFRSIT.

After a review of the material contained herein, personnel are expected to take and pass an exam to an accuracy of at least 80%.

High Performance CPR (HPCPR)

Contraindications

• Less than 24 hours old;
• Meets criteria for Pronouncement of Death in the Field protocol

Adult (>13 years old)

• Continuous/uninterrupted compressions-no pause for AED application, removal of clothes, ventilations, AED/defibrillator charging, IV access, intubation;
• Pauses less than 10 seconds at end of 2 minute cycle to assess pulse and/or defibrillate;
• Compression depth at least 2 inches;
• Compression rate 100-120 per minute;
• Ventilate every 10th compression during recoil/upstroke-if advanced airway in place, asynchronous ventilations every 6 seconds, regardless of age

Pediatric (24hrs to 13 years old)

• Same continuous/uninterrupted compressions as adult;
• compression : ventilation ratio 30:2 for single rescuer, 15:2 for two or more rescuers;
• Compression rate 100-120 per minute;
• Greater than 1 year old up to 13, compression depth 2 inches-less than 1 year 1.5 inches

Return of Spontaneous Circulation (ROSC)

• Refer to the ROSC protocol of the Maryland Medical Protocols (MMP) for patients that are revived

Reference: 2019 Maryland Medical Protocols, p.281

Lucas© (Mechanical CPR)

Contraindications

• Less than 13 years old

Procedure

• Must not apply until after 2 two-minute cycles of CPR;
• Application must not cause more than 10 second pause in compressions-pauses must be around normal two-minute compression interval, simultaneous with pulse check/rhythm interpretation;
• Application may need to take place over 2 or more two-minute cycles in order to keep pauses below 10 seconds;
• Place in stand-by mode for ROSC patients

Reference: 2019 Maryland Medical Protocols, p.395

Click here to be taken to the training video site for the Lucas 3 (the newest system being purchased by some LFRDs). Choose the Pre-hospital video.

Click here to be taken to the training video site for the Lucas 2.

Termination of Resuscitation (TOR)

Contraindications

• Less than 18 years old;
• Arrest secondary to submersion or hypothermia;
• Pregnant

Providers May Invoke TOR Protocol for Non-Traumatic Arrest If. . .

• Patient meets Pronouncement of Death protocol;
• Patient has received 15 two-minute cycles of CPR and is in asystole OR in VF, pulseless VT, PEA with ETCO2 <15 mmHg

Providers May Invoke TOR Protocol for Traumatic Arrest If. . .

• Patient presents in asystole OR rhythm changes to asystole during resuscitation;
• Patient has received 5 two-minute cycles of CPR according to Trauma Arrest Protocol for patient remaining in VF or PEA

Reference: 2019 Maryland Medical Protocols, p.70

Pronouncement of Death

Indications

• Decapitation;
• Rigor mortis;
• Decomposition;
• Dependent lividity;
• Pulseless, apneic in MCI where system resources required for stabilization of living patients;
• Pulseless, apneic with injury not compatible with life (expect in case of obviously pregnant female, who should be resuscitated and transported to nearest appropriate facility);
• Provider has initiated TOR protocol

Reference: 2019 Maryland Medical Protocols, p.73

AED

Highlights

• Turn it on;
• Perform compressions while charging;
• Hover hands over chest during defibrillation-ready to restart compressions;
• No pulse check right after defibrillation-immediately continue chest compressions;
• If "no shock advised" after 2 minute cycle, check pulse for less than 10 seconds-if none, continue CPR

Contraindications

• Newly born (up to 1 hour after birth)
• Patient exhibiting signs of life

Watch the following video. Note-they are not performing HPCPR, viewing is simply to review AED use.

Reference: 2019 Maryland Medical Protocols, p.269