Cardiac Complications & Support Flashcards
What is the target temperature for a patient who is post-cardiac arrest?
33-36 for 24 hours, but consider 36 if arrhythmia or CV instability. Can extend duration to prevent fever.
What are the 6 minimum clinical criteria required to determine neurological death (NDD)?
(1) Assessment by 2 physicians
(2) Established etiology compatible with NDD.
(3) Absence of confounding factors.
(4) Absent brainstem reflexes
(5) Absent movement
(6) Apnea testing
What are the confounding factors that are required to be absent in neurological determination of death (6)?
(1) Unresusitated Shock
(2) Core Temp < 34C
(3) Severe Metabolic Disorders
(4) Neuromuscular Blockade
(5) Peripheral myopathy or neuropathy
(6) Clinically significant drug intoxication
Which brainstem reflexes must be absent for neurological determination of death (5)?
Pupillary Response
Corneal Response
Gag & Cough
Oculovestibular (Cold Calorics)
What is the oculocephalic (doll’s eyes) response?
While the head is moved passively, conjugate movement of the eyes in the direction opposite the head is expected. An ABSENT or asymmetric response in an unconscious patient suggests brainstem dysfunction.
How is caloric response performed and interpreted?
To perform:
(1) Ensure tympanic membrane is intact.
(2) Irrigate the ear canal with ice cold water.
To interpret:
(A) Normal Response - Slow conjugate gaze deviation toward the irrigated side.
(B) Psychogenic Unresponsiveness - Intact eye deviation WITH nystagmus (fast beating away from irrigated ear) suggests that the patient may not be in a coma.
(C) Absent Response - Indicates brainstem dysfunction.
(D) Asymmetric Response - Could also indicate brainstem dysfunction OR if pupils are normal with normal reflexes and only one eye abducts, while the other fails to adduct, could represent an INO (MLF disruption in the pons).
What is the threshold for completion of apnea testing?
PaCO2 > 60 mmHg AND > 20 mmHg above the pre-apnea baseline, in addition to a pH < or = 7.28
What is the recommended starting PaCO2 and pH prior on ABG prior to beginning apnea testing?
PaCO2 35-45
PH 7.35 - 7.45
How long after cardiac arrest do you need to wait before neurological determination of death?
At least 24 hours
What is the recommended glucose range before neurological determination of death?
Glucose 3-22
What serum sodium range in necessary for NDD?
124-159
What phosphate level is necessary for NDD?
> 0.4
What pH is necessary for NDD?
pH 7.35-7.45
What is the maximum time limit from withdrawal of life sustaining therapy to deceleration of death?
1-2 hours
What are the requirements to determine cardiocirculatory death for organ donation?
Minimum 5 minutes of observed absence of pulse, blood pressure and respiratory effort.
