Adult ROSC / Post-Cardiac Arrest Care Algorithm Flashcards
What are the TWO Phases of the ACLS Healthcare Provider Post-Cardiac Arrest Care Algorithm has TWO Phases
- Initial Stabilization Phase / Post-ROSC Phase
- Continued Management and Additional Emergent Activities
The first phase of the post-Cardiac Arrest Care Algorithm is the “Initial Stabilization Phase” or the “post-ROSC phase.” What are the steps/goals of this phase?
These steps can absolutely occur concurrently, but if prioritization is necessary, follow the order of the ABC’s:
1. AIRWAY - Early ETT placement and monitor/confirm with capnography or capnometry
2. BREATHING: Manage RESPIRATORY Parameters - SAME respiratory rate as when coding, and essentially just normal SpO2 and PaCO2 parameters:
- 10 breaths/min
- SpO2 92%-98%
- PaCO2 35-45
3. CIRCULATION: Manage HEMODYNAMIC Parameters - administer crystalloid and/or vasopressor/inotrope for the following HD goals:
- SBP > 95
- DBP > 60
Additionally and very importantly, get an EKG
The second phase of the post-Cardiac Arrest Care Algorithm is the “Continued Management and Additional Emergent Activities phase.” What’s the overall theme of this phase?
HEART and BRAIN evaluation and treatment: “These evaluations should be done concurrently so that decisions on targeted temperature management (TTM) receive high priority as cardiac interventions”
In the “Continued Management and Additional Emergent Activities” phase, what two organs are you basically thinking about?
Heart and Brain
What are you thinking about with respect to the HEART in the “Continued Management and Additional Emergent Activities” phase?
Consideration for emergent cardiac INTERVENTION if there is:
- a STEMI
- Unstable Cardiogenic shock
- Mechanical circulatory support (eg, ECMO) is required
In order to evaluate the need for any cardiac interventions, you’ll IMMEDIATELY evaluate the EKG, and the patient’s current Hemodynamics will guide decision on cardiac intervention
What are you thinking about with respect to the BRAIN in the “Continued Management and Additional Emergent Activities” phase? Specifically, which one specific thing do you need to see if the patient is doing or not?
You need to see if the patient is FOLLOWING COMMANDS or not (ie, is patient COMATOSE or not)?
Patient is YES following commands. What do you do?
Relevant Critical Care Managment:
1. Continuously monitor CORE TEMPURATURE - esophageal, rectal, bladder
2. maintain NORMAL LABS - normoxia, normocapnia, euglycemia
3. provide continuous or intermittent EEG (ELECTROENCEPHALOGRAM) monitoring
4. LUNG-PROTECTIVE VENTILATION if intubated
patient is NOT following commands. What do you do?
- TTM (Targeted Temperature Management) - different card to go over this in depth
- stat CT Brain
- EEG Monitoring
- Other Critical Care management, as applicable, as would also do if pt was YES following commands
TTM (Targeted Temperature Management). Talk about it.
TTM is started after ROSC if patient is NOT following commands. Start as soon as possible. You begin at 32-36 deg for 24 hours by using a cooling device with a feedback loop
- Note that the upper end of that goal temp (36) is actually just a normal temp
Therapeutic hypothermia is indicated with the following recommendations:
Class I rec: any patient who is comatose following ROSC after being resuscitated for an OUT-of-hospital V-FIB cardiac arrest (key: OUT of hospital and specifically V-FIB)
Class IIb: ROSC after IN-hospital cardiac arrest with ANY initial rhythm (key: IN hospital and ANY rhythm)
Class IIb: ROSC after OUT-of-hospital cardiac arrest where the initial rhythm was PEA arrest (key; OUT of hospital and specifically PEA)
Methods to achieve cooling for TTM:
- Cooling blankets, ice packs, or rapid infusion of 30 mL/kg of ice-cold (4 deg C) LR or NS to reduce tempurature.
What are you at least always thinking about, in terms of diagnosis and treatment, in any ACLS situation, INCLUDING ROSC?
5 Ht’s and 5 T’s, and how you might treat each
Post-Cardiac Arrest Algorithm - printout
