ROSC (Return of Spontaneous Circulation)

Question 1

A healthy ______ is the primary goal of all cardiopulmonary-cerebral resuscitation.

Answer 1

brain

Question 2

In the immediate post resuscitation period what are the most important actions the paramedic can take to restore cerebral function?

Answer 2

Optimize ABCs, oxygenation, and perfusion.

Question 3

When the medic is reassessing the patient what are the 4 most important things to check?

Answer 3

1) Check tube placement
2) Do not hypo or hyperventilate patient
3) Maintain SpO2
4) Maintain PetCO2

Question 4

How many breaths per minute should the ROSC patient receive?

Answer 4

10 breaths per minute. 1 every 6 seconds.

Question 5

What is the optimal SpO2 range of the ROSC patient?

Answer 5

between 92 and 96%

Question 6

What is the optimal PETCO2 range of the ROSC patient?

Answer 6

between 35 and 45 Torr

Question 7

If ROSC was obtained from VF/Pulseless VT what drug and at what rate should be administered?

Answer 7

Amiodarone drip of 150mg over 10 minutes. Followed by an Amiodarone maintenance infustion of 1mg/min.

Question 8

What are the Amiodarone infusion mixing instructions for the ROSC patient?

Answer 8

Dilute 150mg of Amiodarone in 100mL of DW5 to yield and concentration of 1.5 mg/mL.

Question 9

What two diagnostic procedures should you perform on the ROSC patient?

Answer 9

12 Lead and a blood glucose level.

Question 10

What drug and at what rate should be given for hypotension that is unresponsive to fluid bolus?

Answer 10

Levophed Infusion 0.1 to 0.5 mcg/kg/min titrated to remain a systolic BP of >90mmHg.

Question 11

What are the mixing instructions for Levophed for the ROSC patient?

Answer 11

Dilute 4 mg of Levophed in 250mL of NS to yield a concentration of 16 mcg/mL

Question 12

What drug and at what dose should be given for post resuscitation sedation to maintain airway?

Answer 12

Versed 2.5 to 5 mg slow IVP every 5 minutes as needed. Maximum total is 20 mg.

Question 13

Most patients will require _______ _______ immediately following post resuscitation?

Answer 13

ventilatory assistance.

Question 14

You must avoid hyperventilation, what diagnostic tool should you be using?

Answer 14

Capnography

Question 15

In the ROSC patient, you should elevate the head how many degrees? Why?

Answer 15

15 to 30 degrees, this will assist in increasing cerebral venous drainage and decrease ICP.

Question 16

You should avoid even mild ______. You should consider whether the instability of this patient comes from ______, ________, or _______ problem in the cardiovascular system.

Answer 16

hypotension

volume, pump, or rate

Question 17

A _______ _______ _______ may develop in the immediate post-resuscitation period and is best ______ _________.

Answer 17

supraventricular tachycardia and is best left untreated.

Question 18

Bradycardia in the post resuscitation period should first be managed by__________________ before administration of atropine or other chronotropic agents.

Answer 18

ruling out hypoxia, airway, and/or ventilation problems

Question 19

Why should you closely monitor fluid resuscitation?

Answer 19

Large volumes of fluid can cause increased pre-load that may cause decreased coronary perfusion pressure.