15
·
Once Cardiac Arrest occurs, follow CPR guidelines for discontinuation if 1)patient awakens;
2)rescuers are exhausted; 3) rescuers are in danger;4) patient is turned over to more definitive care;
or 5) patient does not respond to prolonged ( approximately 30 minutes) of resuscitative efforts.
·
Continue to make efforts to seek hospitalization as soon as possible, even in remote third world
settings, and arrange for assisted transport once a facility with defibrillator equipment is reached.
Cardiac arrest may occur days or weeks after initial uneventful recovery of transmural MI.
IV. SPECIFIC SITUATIONS AND THE IMPLEMENTATION OF CPR
A. Hypothermia: Refer to Chapter on Hypothermia
B. Avalanche Victims:
Breathless and pulseless victims of avalanches are usually dead from suffocation and/or
blunt trauma. Hypothermia is often a confounding factor. Clear the airway, protect the
cervical spine, and initiate rescue breathing and chest compressions (CPR) immediately.
Triage avalanche victims without vital signs at the scene according to the criteria of the
ICAR Medical Commission (Category 1A recommendation):
1.
If there is no pulse and core temperature is 32° C or above or burial is less
than 30 minutes, continue CPR for 20 minutes. If successful with CPR,
transfer to a hospital with an Intensive Care Unit. If unsuccessful, stop CPR.
2.
If the core temperature is below 32°C and burial is over 30 minutes, treatment
depends upon the presence of an air pocket (any space around the nose or
mouth, no matter how small):
a.
If an air pocket is present, continue CPR and transfer to a hospital with
cardiopulmonary bypass capability;
b.
If no air pocket is present, stop CPR;
c.
If an air pocket is possible, but not certain, continue and transfer to a
hospital with cardiopulmonary bypass capability or to a closer hospital
where potassium can be measured. Patients with serum potassium
greater than 10 mmol/L have no chance of survival and are declared
dead by asphyxiation. A field technique of rapid serum potassium
determination will soon be available.
C. Cold-Water Submersion: Refer to Chapter on Submersion Injuries
D. Lightning Strike: Refer to Chapter on Lightning Injuries
