Resus - Post-resus (adult) 2015

Question 1

Step 1

Answer 1

Airway and breathing

• SpO2 94-98%
• Advanced airway
• Waveform capnography
• Ventilate lungs to normocapnia

Question 2

Step 2 (after AB)

Answer 2

Circulation

• 12-lead ECG
• Reliable IV access
• IV fluids (crystalloid) for normovolaemia
• Aim SBP above 100mmHg
• Intra-arterial BP monitoring
• Vasopressor/inotrope to maintain SBP

Question 3

Step 3 (after C)

Answer 3

Control temperature

• Constant 32-36°C
• Sedation, control shivering

Question 4

Step 4 (after temp)

Answer 4

Likely cardiac cause?

Question 5

Likely cardiac cause

Answer 5

ST elevation?

• Yes - coronary angiography +/- PCI
• No - consider coronary angiography +/- PCI

Cause for cardiac arrest identified?

• Yes - Admit to ITU
• No - Proceed as not likely cardiac cause

Question 6

Not likely cardiac cause

Answer 6

• Consider CT brain / CTPA
• Treat non-cardiac cause
• Admit to ITU

Question 7

Step 6 (ITU Management)

Answer 7

• Temperature control 32-36°C for min 24h, prevent fever 72h
• Maintain normoxia and normocapnia, protective ventilation
• Optimise haemodynamics (MAP, lactate, ScvO2, CO/Cl, UO)
• Echocardiography
• Maintain normoglycaemia
• Diagnose/treat seizures (EEG, sedation, anticonvulsants)
• Delay prognostication at least 72h

Question 8

Step 7

Answer 8

Secondary prevention

• ICD
• Screen for inherited disorders
• Risk factor Mx

Question 9

Step 8 (final)

Answer 9

Follow up and rehab