Post Resuscitation

 

History:

 

  • Respiratory arrest
  • Cardiac arrest

 

Significant Findings:

 

  • Return of pulse

 

Differential:

 

  • Continue to address specific differentials associated with the original dysrhythmia

 

Treatment:

 

  • Continue ventilatory support
  • 100% Oxygen
  • EtCO2 ideally >20
  • RR <12
  • 12-Lead EKG
  • Place 2nd IV/IO

 

Termination of ventricular rhythms?

 

  • Yes

 

 

 

  • No

 

Sustained Pulse

 

  • Hypotension?

 

 

 

  • STEMI?

 

 

  • Bradycardia?

 

 

PEARLS:

 

  • Rule out pulmonary edema before administration of Normal Saline bolus to a hypotensive patient.
  • If patient remains hypotensive after initial 500 mL Normal Saline, administer an additional 500 mL; total 1,000 mL.
  • If Push Dose Epi is not effective call Medical Control
  • Push Dose EPI: Mix 1 ml of 1:10,000 Epi into 9 ml Normal Saline: gives Epi 1:100,000; Admin 1-2 ml (10-20 mcg) every 3-5 minutes
  • For transcutaneous pacing set rate for 70 beats per minute. Increase current (mA) until electrical and mechanical capture occur or pacing current reaches (200 mA).
  • Amiodarone (Cordarone) is not a primary post-arrest medication unless significant ectopy is present.

 

Amiodarone Infusion

 

  • 150 mg infusion over 10 minutes:
    • Add 150 mg Amiodarone (Cordarone)
    • 50 mL bag Normal Saline
    • administer through a 10 gtt set at 50 drops per minute.

 

1 mg/min infusion:

  • Add 150 mg Amiodarone (Cordarone)
  • 50 mL bag Normal Saline
  • administer through a 60 gtt set at 20 drops per minute.
  • Transport to a PCI capable hospital.