Following return of spontaneous circulation (ROSC) make sure everyone doesn’t leave; there is still lots to be done
- Assess the patient from an ABCDE perspective
- Airway
- The patient should by not have an ET tube in place. Ensure a patient airway and aim for normoxia and normocapnia
- Obtain ABG samples to guide this
- Breathing
- Ensure sats reasonable (aim over 94%) and titrate oxygen to achieve this
- Auscultate the chest
- Obtain a chest radiograph (CXR)
- Circulation
- Obtain further IV access and bloods as necessary and measure the lactate
- Continue fluid resuscitation
- Ausculatate the heart
- Obtain a 12 lead electrocardiogram (ECG) and beside echo
- If myocardial infarction (MI) is the suspected cause of cardiac arrest, early percutaneous coronary intervention (PCI) should be considered
- Disability
- Recheck pupils
- Measure blood glucose and correct any hyper/hypoglycaemia
- Control any seizures with benzodiazepines, anti-convulsants or anaesthetic agents such as thiopental
- Exposure
- Therapeutic hypothermia should be considered for all comatose survivors of cardiac arrest. However, this is a controversial area and should be discussed with the intensive care department.
- Consider whether further resuscitation attempts would be effective or in the patient’s best interests if they were to arrest again; if not then consider a Do Not Attempt CPR (DNACPR) order after discussing the matter with the patient and their loved ones
- If this is not possible due to a low level of consciousness, a decision will have to be made in their best interests
Sumber aciknadzirah.blogspot.com
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