Post-resuscitation care Flashcards
What does the post-cardiac arrest syndrome comprise of?
- post cardiac arrest brain injury
- post-cardiac arrrest myocardial dysfunction
- systemic ischaemia/reperfusion response
- persistent precipitating pathology
What should the arterial blood oxygen saturation be in the range of?
94-98%
What do grossly distended neck veins when the patient is sitting upright indicate?
Right ventricular failure
in rare cases pericardial tamponade
Describe the breakdown of the GCS?
Eye (4)
1. nil
2. to pain
3. to speech
4. spontaneously
Verbal (5)
1. nil
2. incomprehensible sounds
3. inappropriate words
4. confused
5. orientated
Motor (6)
1. nil
2. extension
3. abnormal flexion
4. normal flexion
5. localises
6. obeys command
What tests should be done after restoration of circulation?
- FBC
- Biochem
- 12-lead ECG
- chest radiograph
- ABGs
- echo
- CT
What is the purpose of a CXR post cardiac arrest?
- ensure ETT placement, gastric tube placement and/or CVC
- check for pulmonary oedema
- check for pulmonary aspiration
- exclude pneumothorax
- assess cardiac contour
What is the purpose of ABG after arrest?
- to ensure adequacy of ventilation and oxygenation
- ensure correction of acid/base balance
What is the purpose of an echo after arrest?
- look for causes
- establish LV and RV structure and function
What is the purpose of post-arrest CT?
- exclude intracranial bleed or stroke as primary cause
- exclude pulmonary embolism or other respiratory causes
What does the inflammatory response that occurs post cardiac arrest cause?
vasoplegia and severe vasodilatation
What is usually the best way to maintain BP?
noradrenaline with or without dobutamine and fluid
if this doesn’t work consider IABP
What might guide treatment with inotropes?
- blood pressure
- heart rate
- urine output
- rate of lactate clearance
- central venous O2
What is the target for MAP
Enough to achieve a urine output of 0.5ml kg hr and normal or decreasing lactate
Which patients may need an ICD?
Any patient who has been resuscitated from cardiac arrest in a shockable rhythm outside the contaxt of proven acute STEMI
What are seizures post-cardiac arrest usually a sign of?
Severe hypoxic-ischaemic brain injury
Why is EEG important?
Because status epilepticus may be marked by sedation
What is the target for BM?
4-10
Why is cooling post cardiac arrest beneficial?
suppresses pathways leading to delayed cell death, including apoptosis
decreases cerebral metabolic rate for O2
reduces inflammatory response
What are the recommendations in TTM?
- constant target temp of 32-36
- for all adults with an initial shockable rhythm, OOH cardiac arrest and unconscious after ROSC
- ooh cardiac arrest with any initial rhythm who are unresponsive after ROSC
- duration of 24h
what are the three phases of TTM?
- induction
- maintenance
- re-warming
What are the methods for TTM?
- ice packs/wet towels
- cooling blankets/pads
- water or air circulating blankets
- transnasal evaporative cooling
- intravascular heat exchanger
- ECMO
what is initial cooling facilitated by?
neuromuscular blockade and sedation to prevent shivering
use magnesium sulfate to further reduce shivering threshold
What is the accepted rewarming rate?
0.2-0.5 degrees/hour
What elements of clinical examination are used for prognostication?
- GCS
- pupillary response to light
- corneal reflex
- seizures
What elements of neurophysiological studies are used for prognostication?
somatosensory evoked potentials and electroencephalography (EEG)
What elements of biochemical markers are used for prognostication?
neuron-specific enolase
What elements of imaging studies are used for prognostication?
brain CT and MRI
