13. Post-resuscitation care Flashcards
what does the post-cardiac arrest syndrome comprise?
post arrest brain injury
post arrest myocardial dysfunction
systemic ischaemia/ reperfusion response
persistent precipitating pathology
significant myocardial dysfunction is common after cardiac arrest but typically starts to recover how long after?
by 2-3 days (full recovery may take much longer)
approach to the patient following ROSC?
ABCDE
aim sats of what following ROSC?
94-98%
(some studies suggest an association between hyperoxaemia and poor outcome)
why is achieving normocapnia important to post-arrest neurological function?
hypercapnia increases cerebral blood flow/ blood volume and intracerebral pressure
hypocapnia causes vasoconstriction that may decrease blood flow and cause cerebral ischaemia
a tracheal tube that has been inserted too far will tend to go down the ____ main bronchus
right
therefore failing to ventilate the left lung
what can be done following ROSC to decompress the stomach, prevent splinting of the diaphragm and enable drainage of gastric contents
insert a gastric tube
following ROSC, what does grossly dilated neck veins when the pt is semi-upright indicate about the heart?
may indicate right ventricular failure
in rare cases could be pericardial tampondade
T/F: prolonged CPR is a contraindication to fibrinolytic therapy
false
GCS score
Eyes
1- nil
2- to pain
3- to voice
4- spontaneously
Verbal
1- nil
2- sounds
3- words
4- confused
5- normal
Motor
1- nil
2- extension (decerebrate)
3- abnormal flexion (decorticate)
4- normal flexion
5- localises
6- obey commands
T/F: bicarbonate is recommended in the treatment of acidaemia post arrest
false - it may, paradoxically, increase the intracellular acidosis, as it’s converted to CO2 with the release of hydrogen ions within the cell
only indicated post arrest ass with hyperkalaemia or TCA overdose
investigations to order following ROSC?
FBC - exclude anaemia
Biochem - renal function, electrolytes, glucose, trops
ECG- cardiac rhythm, evidence ACS, evidence of primary arrhythmogenic causes e.g. Brugada, long QT
CXR- position of tracheal tube/ gastric tube/ central venous catheter, evidence pulmonary oedema/ aspiration/ pneumothorax/ cardiac contour
ABG- adequacy of ventilation and oxygenation, correction of acid/ base imbalance
ECHO- identify contributing causes, assess LV and RV structure and function
CT- exclude IC bleed or stroke as cause, exclude PE or other resp causes
post resuscitation myocardial dysfunction often requires ____ support, at least transiently
what meds are used for this most often?
inotropic
noradrenaline with or without dobutamine and fluid is usually most effective
post arrest, if treatment with fluid resuscitation, inotropes and vasoactive drugs is insufficient to support the circulation, consider insertion of what device?
an intra-aortic balloon pump (IABP)
immediately after cardiac arrest there is typically a period of ___kalaemia
hyperkalaemia
subsequent endogenous catecholamine release and correction of met resp acidosis promotes intracellular transportation of potassium»_space; hypokalaemia
give K to maintain conc 4 - 4.5
