Post Resuscitation Care

Post Resuscitation Care

Following return of spontaneous circulation (ROSC) make sure everyone doesn’t leave; there is still lots to be done

  • Assess the patient from an ABCDE perspective
  • Airway
    • The patient should by not have an ET tube in place. Ensure a patient airway and aim for normoxia and normocapnia
    • Obtain ABG samples to guide this
  • Breathing
    • Ensure sats reasonable (aim over 94%) and titrate oxygen to achieve this
    • Auscultate the chest
    • Obtain a chest radiograph (CXR)
  • Circulation
    • Obtain further IV access and bloods as necessary and measure the lactate
    • Continue fluid resuscitation
    • Ausculatate the heart
    • Obtain a 12 lead electrocardiogram (ECG) and beside echo
    • If myocardial infarction (MI) is the suspected cause of cardiac arrest, early percutaneous coronary intervention (PCI) should be considered
  • Disability
    • Recheck pupils
    • Measure blood glucose and correct any hyper/hypoglycaemia
    • Control any seizures with benzodiazepines, anti-convulsants or anaesthetic agents such as thiopental
  • Exposure
    • Therapeutic hypothermia should be considered for all comatose survivors of cardiac arrest. However, this is a controversial area and should be discussed with the intensive care department.
  • Consider whether further resuscitation attempts would be effective or in the patient’s best interests if they were to arrest again; if not then consider a Do Not Attempt CPR (DNACPR) order after discussing the matter with the patient and their loved ones
    • If this is not possible due to a low level of consciousness, a decision will have to be made in their best interests

 

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