Post cardiac arrest care: Difference between revisions
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==Management== | ==Management== | ||
*Maintain perfusion (cerebral) | *Maintain perfusion (cerebral) | ||
**Treat hypotension | **Treat [[hypotension]] | ||
**Ignore hypertension | **Ignore [[hypertension]] | ||
**Maintain normal PaCO2 (~40) | **Maintain normal PaCO2 (~40) | ||
*Target | *Target [[oxygen|normoxia]] | ||
**PaO2 80-120 | **PaO2 80-120 | ||
*[[Therapeutic Hypothermia]] | *[[Therapeutic Hypothermia]] | ||
*PCI | *PCI | ||
**Early reperfusion therapy is important to ID coronaries as ECG cannot reliably predict them in these cases<ref>Kern, KB. Optimal Treatment of Patients Surviving Out-of-Hospital Cardiac Arrest. J Am Coll Cardiol Intv. 2012; 5(6):597-605. doi:10.1016/j.jcin.2012.01.017</ref> | **Early reperfusion therapy is important to ID coronaries as ECG cannot reliably predict them in these cases<ref>Kern, KB. Optimal Treatment of Patients Surviving Out-of-Hospital Cardiac Arrest. J Am Coll Cardiol Intv. 2012; 5(6):597-605. doi:10.1016/j.jcin.2012.01.017</ref> | ||
*Aggressively treat hyperglycemia | *Aggressively treat [[hyperglycemia]] | ||
**No IV fluids with glucose | **No IV fluids with glucose | ||
**RISS | **RISS | ||
*Aggressive seizure treatment | *Aggressive [[seizure]] treatment | ||
**Prophylaxis unproven | **Prophylaxis unproven | ||
*Minimize Irritation | *Minimize Irritation | ||
**Sedatives +/- paralytics | **[[Sedation|Sedatives]] +/- paralytics | ||
**Supine positioning | **Supine positioning | ||
Revision as of 17:03, 25 September 2019
Management
- Maintain perfusion (cerebral)
- Treat hypotension
- Ignore hypertension
- Maintain normal PaCO2 (~40)
- Target normoxia
- PaO2 80-120
- Therapeutic Hypothermia
- PCI
- Early reperfusion therapy is important to ID coronaries as ECG cannot reliably predict them in these cases[1]
- Aggressively treat hyperglycemia
- No IV fluids with glucose
- RISS
- Aggressive seizure treatment
- Prophylaxis unproven
- Minimize Irritation
- Sedatives +/- paralytics
- Supine positioning
Prognostication[2]
- Out-of-hospital cardiac arrest (OHCA) has about a 10% survival to discharge rate
- In-hospital cardiac arrest has just over a 20% survival to discharge rate
- About half will have no to mild disability, and the other half will have moderate to severe disability
- Lack of pupillary reflexes upon ROSC after OHCA are not reliable in prognosticating return of neurologic function
See Also
References
- ↑ Kern, KB. Optimal Treatment of Patients Surviving Out-of-Hospital Cardiac Arrest. J Am Coll Cardiol Intv. 2012; 5(6):597-605. doi:10.1016/j.jcin.2012.01.017
- ↑ Breu AC. Clinician-Patient Discussions of Successful CPR—The Vegetable Clause. JAMA Intern Med. 2018;178(10):1299–1300. doi:10.1001/jamainternmed.2018.4066