Part 9:Post Cardiac Arrest Care Flashcards
What are the initial objectives of post-cardiac arrest care according to AHA 2010?
Optimize cardiopulmonary function and vital organ perfusion
Transport to appropriate hospital with comprehensive post-cardiac arrest treatment system
Transport in-hospital post-cardiac arrest patient to an appropriate critical care unit
Try to identify and treat the precipitating causes of the arrest and prevent recurrent arrest
When can fluid boluses be considered in post-cardiac
arrest?
Hypotension (BP < 90mmHg)
What should a practitioner look for on a 12 ECG before or following cardiac arrest?
ST elevation or new or presumably new LBB
In post cardiac management, how should the inspired
oxygen be titrated to avoid potential oxygen toxicity?
To the lowest level required to achieve an arterial oxygen
saturation of >= 94%
What is the most common cause of cardiac arrest in an
adult overall according to AHA 2010?
Cardiovascular disease
Coronary ischemia
What should rescuers or long-term hospital providers
avoid in terms of airway management during post cardiac
arrest management according to AHA 2010?
- Avoid using ties that pass circumferentially around the patient’s neck, potentially obstructing venous return from brain
- They should elevate the head of the bed 30degrees if tolerated to reduce the incidence of cerebral oedema,aspiration and ventilatory-associated pneumonia
Which drug should adrenergic drugs not be mixed with
and why?
Sodium Bicarbonate, or other alkaline solutions because there is evidence that adrenergic agents are inactivated in alkaline solutions.
What are the clinical manifestations of post-cardiac arrest
brain injury according to AHA 2010?
- Coma
- Seizures
- Myoclonus
- Various degrees of neurocognitive dysfunction
- Brain death
What are the strategies that can improve pulmonary
function and PaCO2 while the practitioner is determining
the pathophysiology of the pulmonary dysfunction?
- PEEP, a lung-protective strategy for mechanical ventilation, and
- titrated FiO2
What are the common causes of pulmonary dysfunction
after cardiac arrest?
- Hydrostatic pulmonary oedema from left ventricular dysfunction
- Noncardiogenic oedema from inflammatory, infective, or physical injuries
- Severe pulmonary atelectasis
- Aspiration occurring during cardiac arrest or resuscitation
What should a correct placement of advanced airway be monitored with?
Waveform capnography
What should be the HGT target for post-cardiac arrest patient?
8 to 10mmol/L
What is the minimum systolic BP that should be achieved when titrating administration of adrenaline?
Systolic BP >=90mmHg or MAP >=65mmHg
What are the subsequent objectives of post-cardiac arrest care?
Control of body temperature to optimize survival and neurological recovery Identify and treat acute coronary syndrome (ACS) Optimise mechanical ventilation to minimize lung injury Reduce the risk of multi-organ injury and support organ function if required Objectively assess prognosis for recovery Assist survivors with rehabilitation services when required
What precipitating causes of cardiac arrest should receive attention in cardiac or post-cardiac arrest?
H’ and T’ Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hyper/hypokalemia, Moderate to severe Hypothermia Toxins Tamponade (cardiac) Tension pneumothorax Thrombosis of the coronary or pulmonary vasculature
