chap 13 Flashcards
what are the post cardiac arrest syndromes ?
post cardiac arrest brain injury : coma , seizure ,myoclonus , neurocognitive dysfunction and brain death
post cardiac arrest myocardial dysfunction : common , but recovers in 2-3 days
systemic schema / reperfusion response : activates immune and coag pathways contributing to multiple organ failure
persistent precipitating pathology
what should be done in post resus care ?
A-E
AB
ventilate lungs to normocapnia
C
SBP AIM >100 or mean blood pressure above 65mmhg
CONTROL TEMP 32-36 degrees - TTM for atleast 24 hours
SEDATE AND VENTILATE THE PATINET FOR 24 HOURS AFTER ROSC
likely cardiac cause ? ==> no =====> CT BRAIN OR CTPA
cardiac cause ===== yes ===== EG st elevation ===== PCI and coronary angio
admit to ICU
ICU Mx
temp control needed 32-36 degrees for > 24 hours to prevent fever for atleast 72hr
maintain normocapni
avoid hypotension
echo
maintain normoglycemia
diagnose and treat seizures - CONTINIOUS EEG as seizures can be masked by sedation
post resus care rib fractures lead to ?
and tx ?
pneumothorax and fail chest wall segment
when is TTM (targeted temp Mx) needed?
who remans comatose after ROSC
TX for post resus myocardial dysfunction ?
not dobutamine - even though most established in myocardial dysfunction = systemic inflammatory response leading to vasoplegia and vasodilation
thus noradrenaline with fluid is used
if insufficient consider - intra-aortic balloon pump
immediately after cardiac arrest what is the electrolyte abnormality ?
hyperkalema
endogenous catechlomien release and correction of metabolic and resp acidosis may cause - hypokalaemia
hypokalaemia predisposes to ventricular arrythmia
why do we sedate and ventilate the taint after ROSC ?
reduce oxygen consumption
hypothermia under sedation can prevent shivering - enables TTM to be achieved more rapidly
seizures indicate ?
hypoxic ischemic brain injury
poor prognosis
most typical seizures after post resus?
myoclonus
typicallydevelopes first 1-2 days
transient during first week
is routine seizure prophylaxis given ?
no
temperature post resus
period of hyperthermia common in first 2-3 days
treat with anti paretics or active cooling
because hyperthermia related to poor outcome
TTM indications ?
remain unresponsive after ROSC
TTM duration ?
atleast 24hrs
how to achieve TTM ?
induction - maintenance - rewarming
induction :
after ROSC hypothermia usually in the first hour
33degrres if lower target temp chosen = 30ml/kg of 4 degrees saline or hartman solution
neuromuscular blockade - prevent shivering and sedation
magnesium sulphate - reduce shivering threshold
simple icepacks , wet towels
cooling blankets and pads
water/air circulating blanked
maintenance
thermostat placed in bladder or oesophagus
rewarming
SHOULD BE ACHIEVED VERY SLOWLY because electrolyte conc , intravascular volume and metabolic rate can change v rapidly
0.25-0.5 degrees rewarming per hour
