ROSC

Question 1

Principle ROSC

Post ROSC aim

(4)

Answer 1

To continue respiratory support

Maintain cerebral perfusion

Prevent arrhythmias

Treat the cause of arrest

Question 2

Principle ROSC
Airway and breathing
(2)

RR=
%

Avoid
(3)

Answer 2

Maintain airway by raising 30 degrees where appropriate to prevent passive regurgitation

Capnography to monitor ventilation rates and waveform to determine re-arrest

RR = 10-12 (5-6 secs)
SpO2 - 94-98%

Avoid
Hypo/hyper inflation
Hypo/hyper oxaemia
Hypo/hyper capnia

Question 3

Principle ROSC
Circulation

Fluid

Aim

Why

Ischemic?

Answer 3

10ml/kg to MAX 1000ml - reassess every 250ml

Aim to SBP of 100mm/Hg or Radial pulse

Hypotension may exacerbate brain injury

Consider coronary perfusion - STEMI

Question 4

Principle ROSC
Coronary reperfusion and other considerations

STEMI in ROSC

BGL *how much * paeds

TEMP

Answer 4

STEMI can be called and is appropriate as persistent elevation indicates coronary occlusion as a cause.

4-10mmol - *administer the minimal amount - high BGL post ROSC is associated with poor neurological outcomes - follow with 100ml flush
Paeds - Consult for BGL management - 1ml/kg flush - 2mg/kg titrated - followed by 1ml/kg flush
Aim to be in normal range -

Hyperthermia aggravates reperfusion injury and neuronal damage. Passive cooling, removing blankets should be considered.

Question 5

Principle ROSC

Hospital destination in ROSC (3)

Answer 5

SPINE or tQEH if safe to do so

Clinical support Is required for bypass

If patient is unstable or clinical support is unavailable, closest ED

Question 6

Principle ROSC

Paeds in ROSC (5)

Answer 6

Early EOC consult - SAAS medical practitioner

Avoid Hypoxia - Paramount to outcome

BGL is of high importance - HYPO is common

Maintain Normal BP - Consult RDR chart

Temperature should be managed