ROSC (google docs )

Question 1

What is the first step in treatment following ROSC?

Answer 1

Gain IV access if not already achieved.

Question 2

What should be ensured regarding airway and breathing after ROSC?

Answer 2

Ensure an adequate airway and adequate breathing, but avoid hyperventilation: Ventilate to an ETCO2 of 35-45 mmHg if an ETT or SGA has been placed.

Question 3

What should be administered if the patient is ventilated via an ETT?

Answer 3

Administer sedation, analgesia and neuromuscular blockade if required, using the ‘post intubation’ guideline.

Question 4

What is the target SpO2 after 15 minutes following ROSC?

Answer 4

Titrate the oxygen flow rate/FiO2 to an SpO2 of 94-98%.

Question 5

What is the target systolic BP for adults and children after ROSC?

Answer 5

Target a systolic BP of greater than or equal to 100 mmHg in an adult, and greater than or equal to the normal predicted systolic BP in a child.

Question 6

What should be done if the systolic BP is lower than the target?

Answer 6

Consider administering 500 ml of 0.9% sodium chloride IV. Repeat once if required.

Question 7

What should be done if the patient has STEMI or dysrhythmia?

Answer 7

Acquire a 12 lead ECG and treat as per the appropriate guideline.

Question 8

What is the purpose of the post cardiac arrest checklist?

Answer 8

Utilise the post cardiac arrest checklist prior to commencing transport.

Question 9

What should be confirmed before transport?

Answer 9

Confirm appropriate transport destination.

Question 10

What are the general principles of post cardiac arrest care?

Answer 10

Maintain an adequate airway, breathing and circulation, avoiding hypoxia, hyperventilation and hypotension.

Question 11

What is targeted temperature management (TTM)?

Answer 11

TTM may also be described as therapeutic hypothermia and improves outcomes in patients remaining unconscious following a cardiac arrest.

Question 12

What is the target temperature for TTM?

Answer 12

Target a temperature of 35-36°C if core temperature monitoring is available.

Question 13

What should be documented post ROSC?

Answer 13

Document the patient’s tympanic temperature post ROSC, but this is not a priority.

Question 14

When is active warming indicated?

Answer 14

There is no role for active warming unless the patient has had a cardiac arrest secondary to hypothermia.

Question 15

When is active cooling indicated?

Answer 15

There is no role for active cooling unless the patient has hyperthermia.

Question 16

What is the risk of high levels of oxygen post cardiac arrest?

Answer 16

Very high levels of oxygen may worsen outcomes by causing vasoconstriction and promoting inflammation within the brain.

Question 17

What should be done if pulse oximetry is unreliable?

Answer 17

Ventilate with an oxygen flow rate of 10 litres/minute or an FiO2 of 100%.

Question 18

What is the target ETCO2 for a patient ventilated via an ETT or SGA?

Answer 18

The target ETCO2 is 35-45 mmHg.

Question 19

What is the importance of maintaining blood pressure post cardiac arrest?

Answer 19

A fall in blood pressure will further reduce blood flow to the brain, hence a systolic BP greater than 100 mmHg is targeted for adults.