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
