Page 57 - 2023 SMOG Digital

Cardiac

POST-CARDIAC ARREST CARE

Signs and Symptoms: Differential Diagnosis:
• Return of Spontaneous • Continually Address
Circulation Primary Pathology
• Pulse Associated with Arrest
• Respirations
Universal Patient Care Guideline
Consider as appropriate:
Hypotension • Continuous Monitoring and Maintain: Post-Resuscitation Induced
Circulation: Palpable Pulses and BP
(SBP <90 mmHg) • O2: Sat <90% (may need advanced airway) Hypothermia Guideline
• 12 lead ECG / Defibrillator
• IV/IO access (IV Guideline)
Fluid bolus *See pearls Loss of Pulses, or onset of VF/
Reperfusion and Trauma pulseless VT, asystole/PEA:
Patients Changes in Pulses or Move to Cardiac Arrest
Guideline
Significant Ectopy
Symptomatic Bradycardia move to
For Refractory Hypotension Bradycardia with Pulse
Consider: Reversible Causes: Guideline
Norepinephrine • Hypovolemia
0.1-0.5mcg/kg/mil • Hypoxia
Epinephrine
2-10mcg/min • Hydrogen ion (acidosis) Symptomatic Tachycardia,
• Hypo-hyperkalemia Pulse >150/min move to
• Hypothermia Tachycardia with Pulse
Consider Treatable Causes • Hypo-Hyperglycemia Guideline
• Tension pneumothorax
• Tablets/toxin
Move to appropriate Cardiac • Tamponade, cardiac
guideline (opposite side of page) • Thrombus–cardiac
based on changes in Pulse and • Thrombus–pulmonary
ECG.
Pearls:
• Hyperventilation may cause hypotension and/or recurrence of cardiac arrest in the post-
resuscitation phase and must be avoided.
• Most patients will require ventilator assistance in the post-resuscitative phase.
• In non-airway controlled patients, it is important to prevent aspiration following resuscitation. For
this reason, patients should be rotated onto their side (non-spinal immobilization) or be closely
monitored in case vomiting occurs.
• *Reperfusion: 1-2L IVF and consider use of a pressor IV/IO Drip – EPINEPHRINE 2–10mcg/min
or NOREPINEPHRINE 0.1–0.5mcg/kg/min: 70kg adult: 7–35mcg/min.
o Dopamine should be started at a low dose (5mcg/kg/min) and titrated up to maintain
a SBP >90. The same applies norepinephrine.
• *Trauma patients post-resuscitation should have fluid resuscitation consistent with hypotensive
resuscitation guidelines. Maintain body core temperature 32-36 degrees C for at least 24 hours

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