IMMEDIATE POST-CARDIAC ARREST CARE ALGORITHM Flashcards
DDx: Cardiac Arrest
Cardiac:
MI -> VF / VT
Arrythmia
Bradycardia
Aortic Dissection
Tamponade
PE
Pulmonary:
Upper Airway Obstruction
Respiratory Arrest - COPD / Asthma / Narcotics
PTX
Tox / Metabolic:
Overdose
Hypoglycemia
Hyper / Hypokalemia
Hypomagnesemia
Other:
Anaphlaxis
Septic Shock
IC Hemorrhage
Hemorrhage
Hypothermia
Post Arrest Investigations
POCG
Lytes, Ca / Mg / Pho, CBC, INR, aPTT
Lactate
Troponin
+/- Bld Clx
+/- bHCG
ABG (post intubation, q 2 h)
EKG
POCUS:
-Pulm r/o post CPR PTX
-Cardiac r/e LVF
-Abd FAST
CXR
+/- CT Head
Elements of post-cardiac arrest care
ventilation and oxygenation optimization
hemodynamic optimization
(TTM) Targeted Temperature Management
immediate coronary reperfusion with PCI (percutaneous coronary intervention)
glycemic control
neurologic care
other technical interventions
Ventilation Management
Start at 10 breaths / min
Target PETC02 of 35-40 mm Hg
Target Pa02 102
ABG q2h then q 4 hr
Consider advanced airway and waveform capnography
Do not hyperventilate
Elevate the bed to 30 degrees
Hemodynamic Management
SBP > 90
MAP > 65
Consult Cardio if suspicious of MI
+/- Start DAPT, Heparin / Fonduparinux
Epinephrine IV infusion dose and rate. What is the dose for a 70 kg adult?
4 mg in 250 mL NS or D5W (16 ug/ml)
0.01-0.5 mcg/kg/min
Usual 0-0.3 mcg/kg/min
70 kg adult: 7-35 mcg / min
Dopamine IV infusion dose and rate. What is the dose for a 70 kg adult?
400 mg in 250 ml D5W (1600 mcg/ml)
2-20 mcg / kg / min
Usual dosing 0-10 mcg/kg/min
70 kg adult: 350 - 700 mcg / min
Norepinephrine IV infusion dose and rate. What is the dose for a 70 kg adult?
4 mg OR 8 mg in 250 ml saline = 16 ug / ml or 32 ug / ml
0.05 - 0.5 ug / kg / min ~
0.1-0.3 most common
if BP in boots (SBP 70 start at 0.3)
70 kg adult: 7-35 mcg / min
Amiodarone dose
Amiodarone
150 mg IV infusion over 10 min
THEN
360 mg IV infusion over 6 hrs
THEN
540 mg IV infusion over 18 hrs
Neuro targets
TTM:
</37.5 C / 24 hr via bladder or rectal probe
Ice cold isotonic non glucose containing fluid (30 ml / kg)
Propofol 0-4 mg / kg / hr
Tylenol 1000 mg q 6 hr
+/- Buspiron 30 mg ETT q 8
Renal Targets
Mg Repletion target >0.8 mM