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Chapter 10 : Post-Cardiac arrest care

Post-Cardiac Arrest Care

During proper resuscitation there may be return of spontaneous circulation (ROSC) where adequate post-cardiac arrest care is crucial for the survival and good quality of life of the patient.

The following is ACLS post cardiac arrest care algorithm:

  1. Check rhythm during ACLS survey, note the patient’s rhythm is organized and there is a pulse
  2. Optimize ventilation and oxygenation by maintaining oxygen saturation ≥94%, use an advanced airway and use waveform capnography to monitor correct placement of tubes
  3. Treat hypotension (SBP <90 mmHg) by using the following:
    1. IV bolus 1-2 L normal Saline
    2. Epinephrine 0.1 – 0.5 mcg/kg per minute IV infusion to reach SBP of >90 mmHg or mean arterial pressure of >65 mm Hg
    3. Dopamine 5-10 mcg/kg per minute IV infusion to reach SBP of >90 mmHg or mean arterial pressure of >65 mm Hg
    4. Norepinephrine 0.1 – 0.5 mcg/kg per minute IV infusion to reach SBP of >90 mmHg or mean arterial pressure of >65 mm Hg
  4. Check to see if patient can follow verbal commands.  If the patient is not able to follow verbal commands, consider induced hypothermia and cool patient’s core temperature to 32 and 34 degrees Celsius. If the patient is able to follow verbal commands then go straight to getting a 12-lead ECG
  5. Get a 12-lead ECG right after ROSC to determine if the patient has STEMI or AMI and coronary reperfusion should be attempted right away
  6. Transfer the patient to an intensive care unit
Learning Outcomes:

You have completed Chapter X. Now you should be able to:

  1. Apply the Post Cardiac Arrest Care Algorithm once the patient is in ROSC