Post Resuscitation Care Flashcards
What does post cardiac arrest syndrome comprise?
Brain injury
Myocardial dysfunction
Systemic ischaemia / reperfusion response
Persistent precipitating pathology
How does post cardiac arrest brain injury demonstrate?
Coma, seizures, myoclonus, brain death, neurocognitive dysfunction
Do all patients who have cardiac arrest need intubation?
No, if it was brief and tx applied appropriately
What ventilation optimisation after cardiac arrest should be undertaken and why?
Keep spo2 between 94-98% to reduce free radical damage.
Keep the patient at normal CO2 as associated studies show hypocapnia to have less ideal outcomes
Insert NG
watch for pneumothorax
If the patient regains consciousness, consider extubation or otherwise you are going to have to sedate so no coughing on tube to reduce stress on the patient and their heart
What is the post resus algo?
What does hypo perfusion cause?
Metabolic acidosis
What does hypo perfusion cause?
Metabolic acidosis
What is the most important way to correct the acidemia post cardiac arrest?
Address the cause - eg. Poor perfusion - give fluid and inotropic drugs
Do not routinely give sodium bicarb as this can worsen intracellular acidosis as it gets converted to carbon dioxide within the cell
What tests post stabilisation should occur?
What heart support is often needed?
Dobutamine and often Norad (due to vasoplegia + LV failure)
What BP and urine output should be targeted post arrest?
Systolic of at least 100mmHg
Uring 1ml / kg / h
What two blood tests need to be monitored closely post arrest?
Lactate / potassium (keep at 4.0-4.5mmol/L)
How common are seizures post arrest?
1/3 (who remain comatose after rosc)
Monitor eeg intermittently (whether tx of seizures helps for outcome is unknown)
However, tx may reduce cerebral metabolism and reduce brain injury - tx with sodium valproate, racetam, phen, benzo, prop
Propofol might be effective for myoclonus control
Routine seizure control is not recommended
Myoclonus and seizures are related to poor prognosis
What sugar levels post arrest?
Greater and equal to 4
Less than or equal to 10
Should you treat hyperthermia post arrest and how?
Antipyretic and active cooling
