IMMEDIATE POST-CARDIAC ARREST CARE ALGORITHM

Question 1

DDx: Cardiac Arrest

Answer 1

Cardiac:
MI -> VF / VT
Arrythmia
Bradycardia
Aortic Dissection
Tamponade
PE

Pulmonary:
Upper Airway Obstruction
Respiratory Arrest - COPD / Asthma / Narcotics
PTX

Tox / Metabolic:
Overdose
Hypoglycemia
Hyper / Hypokalemia
Hypomagnesemia

Other:
Anaphlaxis
Septic Shock
IC Hemorrhage
Hemorrhage
Hypothermia

Question 2

Post Arrest Investigations

Answer 2

POCG
Lytes, Ca / Mg / Pho, CBC, INR, aPTT
Lactate
Troponin
+/- Bld Clx
+/- bHCG
ABG (post intubation, q 2 h)
EKG
POCUS:
-Pulm r/o post CPR PTX
-Cardiac r/e LVF
-Abd FAST
CXR
+/- CT Head

Question 3

Elements of post-cardiac arrest care

Answer 3

ventilation and oxygenation optimization
hemodynamic optimization
(TTM) Targeted Temperature Management
immediate coronary reperfusion with PCI (percutaneous coronary intervention)
glycemic control
neurologic care
other technical interventions

Question 4

Ventilation Management

Answer 4

Start at 10 breaths / min
Target PETC02 of 35-40 mm Hg
Target Pa02 102
ABG q2h then q 4 hr
Consider advanced airway and waveform capnography
Do not hyperventilate
Elevate the bed to 30 degrees

Question 5

Hemodynamic Management

Answer 5

SBP > 90
MAP > 65
Consult Cardio if suspicious of MI
+/- Start DAPT, Heparin / Fonduparinux

Question 6

Epinephrine IV infusion dose and rate. What is the dose for a 70 kg adult?

Answer 6

4 mg in 250 mL NS or D5W (16 ug/ml)

0.01-0.5 mcg/kg/min
Usual 0-0.3 mcg/kg/min

70 kg adult: 7-35 mcg / min

Question 7

Dopamine IV infusion dose and rate. What is the dose for a 70 kg adult?

Answer 7

400 mg in 250 ml D5W (1600 mcg/ml)

2-20 mcg / kg / min
Usual dosing 0-10 mcg/kg/min

70 kg adult: 350 - 700 mcg / min

Question 8

Norepinephrine IV infusion dose and rate. What is the dose for a 70 kg adult?

Answer 8

4 mg OR 8 mg in 250 ml saline = 16 ug / ml or 32 ug / ml

0.05 - 0.5 ug / kg / min ~

0.1-0.3 most common

if BP in boots (SBP 70 start at 0.3)

70 kg adult: 7-35 mcg / min

Question 9

Amiodarone dose

Answer 9

Amiodarone
150 mg IV infusion over 10 min
THEN
360 mg IV infusion over 6 hrs
THEN
540 mg IV infusion over 18 hrs

Question 10

Neuro targets

Answer 10

TTM:
</37.5 C / 24 hr via bladder or rectal probe
Ice cold isotonic non glucose containing fluid (30 ml / kg)
Propofol 0-4 mg / kg / hr
Tylenol 1000 mg q 6 hr
+/- Buspiron 30 mg ETT q 8

Question 11

Renal Targets

Answer 11

Mg Repletion target >0.8 mM