Question: In the situation of being an ACP making a rendezvous with a PCP crew to assist on a medical cardiac arrest patient that they already initiated transport with and did not arrest on route, would you suggest once we make patient contact to administer 3 EPI q4/lidocaine or amio/saline bolus (depending on rhythms), BHP patch and then continue transport or continue transport and administer epi q4 until transfer of core or ROSC? There seems to be different opinions about this in my service. I appreciate you taking the time to answer.

Question: Is it advised that when a patient is not adequately perfusing but still technically with a pulse, that CPR be commenced? In discussing this with my colleagues, we are speaking in regards to a patient who may technically still have an idioventricular or agonal pulse and is circling the drain. Instead of waiting the 30 sec-1 min for the patient to be completely VSA, would it not be better to get on the chest and begin compressions in an attempt at increasing perfusion?

Question: When managing a cardiac arrest as a PCP and following the Medical Cardiac Arrest Medical Directive, if the patient does not qualify for a TOR (shock delivered, ROSC obtained at some point etc.), why is it required to patch to the BHP (Mandatory Provincial Patch Point) for authorization to transport when it is clear that transport is the only option?

Question: There was a question posted in January 2012 that asked if CO poisoning leading from VSA would be considered an unusual circumstance and whether performing one analysis and transporting would be acceptable. Medical Councils answer was that this would be analogous to an asphyxial cardiac arrest such as a drowning and hanging. In these cases, the SWORBHP Medical Directors have preferred that the Medical Cardiac Arrest Medical Directive be followed.

This question was asked a long time ago, however, during one of my Base Hospital training sessions, I was told by an Educator that CO (it specifically said) does fall under an “unusual circumstance” and therefore you would transport after the first analysis leading to a NO SHOCK ADVISED.

Can you clarify what should be done?

Question: This question is in regards to timing during a medical VSA. Would your 2 minutes in between analysis restart when you stop to analyse or after you have analysed or shocked? For example, you stop to analyse at 1500:00 and you start your CPR at 1500:10 after shock or no shock, would your next analyze be at 1502:00 or 1502:10?

Question: If a doctor is someone who can assume care of a VSA patient and decide to have resuscitative efforts ceased, then why is a doctor not someone who counts as a witness in the ‘unwitnessed arrest’ condition of a TOR, along with paramedics and firefighters? Thanks in advance.

Question: I have overheard a couple of crews recently discussing the ACP cardiac arrest protocol for when you arrive on-scene and a PCP has already initiated their protocol.

I’ve overheard that some crews use what the PCP crew has done (say two no shocks) and then just do two more and either call for pronouncement or transport. I also know other crews that will show up and do their entire three rounds of epi, etc. and then call/leave regardless of how many or what the first arriving PCP crew has done.

I know what I do but which one is actually correct because now I’m wondering if I’m doing the right method.

Question: You respond to a call for a 57 year old male patient who collapsed while cutting the lawn. On arrival, his neighbour who witnessed the arrest, reports that she saw him fall and when she checked on him, she realized that he was in cardiac arrest and started CPR. You confirm that the patient is VSA and quickly apply the defib pads. You deliver one shock and start CPR again but the patient begins to moan and tries to raise his arms. Your next action would be to…?