Progress Note - Cardiac Arrest Timeline

[TIME] Patient presents via [EMS/private vehicle] unresponsive with no palpable pulse with evidence of [asystole/pulseless electrical activity (PEA)/ventricular tachycardia/fibrillation].  Patient noted to have [no] evidence of shockable rhythm [with defibrillation delivered].  CPR initiated at this time while [IV/IO] access was obtained.

[TIME] Patient noted to be in [asystole/pulseless electrical activity (PEA)/ventricular tachycardia/fibrillation] on first rhythm check [with no indication for defibrillation/defibrillation at ### J delivered at this time and CPR immediately resumed].  Patient given [Epinephrine/Amiodarone/Atropine] as noted in nursing paperwork.

[TIME] Patient noted to be in [asystole/pulseless electrical activity (PEA)/ventricular tachycardia/fibrillation] on second rhythm check [with no indication for defibrillation/defibrillation at ### J delivered at this time and CPR immediately resumed].  Patient also given [additional/second dose of Epinephrine/Amiodarone/Atropine] as noted in nursing paperwork.

[TIME] Patient noted to be in [asystole/pulseless electrical activity (PEA)/ventricular tachycardia/fibrillation] on third rhythm check [with no indication for defibrillation/defibrillation at ### J delivered at this time and CPR immediately resumed].  Patient given [Epinephrine/Amiodarone/Atropine] as noted in nursing paperwork.  We considered additional reversible causes at this time to include hypoxia, hypovolemia, hypothermia, hyperkalemia, acidosis, tension pneumothorax, tamponade, pulmonary and cardiac thrombosis, and various etiologies of overdose, and initiated treatment with [describe intervention].

[TIME] Patient noted to be in [asystole/pulseless electrical activity (PEA)/ventricular tachycardia/fibrillation] on fourth rhythm check [with no indication for defibrillation/defibrillation at ### J delivered at this time and CPR immediately resumed].  Patient given [Epinephrine/Amiodarone/Atropine] as noted in nursing paperwork.

[TIME] Patient noted to have palpable [carotid/femoral/radial] pulse on [number] rhythm check with [sinus rhythm/bradycardia/tachycardia] on the monitor consistent with return of spontaneous circulation (ROSC).  Post-resuscitative care initiated to include maximizing oxygenation and ventilation [with advanced airway placed at this time], addressing hypotension [with IV/IO fluid bolus/vasopressor initiation/further consideration of treatable causes], and initiation of targeted temperature management [with cool IV fluids/etc.].  We also obtained a 12-lead EKG which was [noted to be unremarkable/notable for evidence of STEMI with discussion with Cardiology and plan for transfer of the patient to the catheterization lab].

MDM - Cardiac Arrest - Return of Spontaneous Circulation (ROSC)

[##]-year-old [male/female] presented in cardiac arrest with successful return of spontaneous circulation (ROSC) in the ED.

Patient presented via [private vehicle/ambulance] and was noted to be [in peri-arrest with rapid loss of cardiac activity/pulseless, apneic and unresponsive] with an initial rhythm assessment showing [pulseless electrical activity/asystole/ventricular tachycardia/fibrillation].  CPR initiated as noted above with patient receiving [## doses of Epinephrine/## doses of Amiodarone/## doses of Atropine/and defibrillated ### times].  We considered alternate causes for cardiac arrest to include hypoxia, hypovolemia, hypothermia, hyperkalemia, acidosis, tension pneumothorax, tamponade, and various etiologies of overdose, and addressed these etiologies with [respiratory support and intubation/IV fluid bolus/passive warming of the patient/## doses of Sodium Bicarbonate/needle decompression/etc.].  A bedside ultrasound was performed with [evidence of uncoordinated cardiac activity/absence of cardiac wall motion and no evidence of pericardial effusion].  Patient was reported to have had a [## minute] down time with [unwitnessed/witnessed] arrest.  Patient noted to be have gone from [initial rhythm] to [additional rhythms] during resuscitation that lasted [## minutes].

Patient noted to have ROSC after [## minutes] of resuscitation in the ED.  We initiated post-resuscitative care in the ED as noted above.  A 12-lead EKG was obtained [and noted to be unremarkable/noted to have evidence of STEMI and the patient was transferred to the cardiac catheterization lab].  We discussed the case with Dr. [NAME] of the ICU with plan for admission of the patient for further management.  We discussed planned admission with the patient’s [wife/husband/family] who agreed with planned admission.

MDM - Cardiac Arrest - Pronounced

[##-year-old male/female] presented in cardiac arrest with unsuccessful resuscitation and pronouncement in the ED.

Patient presented via [private vehicle/ambulance] and was noted to be [in peri-arrest with rapid loss of cardiac activity/pulseless, apneic and unresponsive] with an initial rhythm assessment showing [pulseless electrical activity/asystole/ventricular tachycardia/fibrillation].  CPR initiated as noted above with patient receiving [## doses of Epinephrine/## doses of Amiodarone/## doses of Atropine/and defibrillated ### times].  We considered alternate causes for cardiac arrest to include hypoxia, hypovolemia, hypothermia, hyperkalemia, acidosis, tension pneumothorax, tamponade, and various etiologies of overdose, and addressed these etiologies with [respiratory support and intubation/IV fluid bolus/passive warming of the patient/## doses of Sodium Bicarbonate/needle decompression/etc.].  A bedside ultrasound was performed with [evidence of uncoordinated cardiac activity/absence of cardiac wall motion and no evidence of pericardial effusion].  Patient was reported to have had a [## minute] down time with [unwitnessed/witnessed] arrest.  Patient noted to be have gone from [initial rhythm] to [additional rhythms] during resuscitation that lasted [## minutes].

Patient noted to have persistent [asystole/pulseless electrical activity] despite [## minutes] of resuscitation in the ED.  Even after consideration and attempted treatment of reversible causes, we were unable to convert the patient into a perfusing rhythm.  The patient was pronounced in the ED at [TIME] with family [notified/at the bedside].  We [offered/consulted a Chaplain/Social Worker] for the family, and arranged for appropriate care of the deceased patient and transfer to the morgue.