Chapter 13 Flashcards
(17 cards)
Post-resuscitation oxygen saturation target
94-98%
Effect of resuscitation on blood pH/CO2
Causes mixed respiratory acidosis and metabolic acidosis due to hypoventilation and poor tissue perfusion.
Aim for normocarbia - monitor end-tidal volume and ABG
Where will a tracheal tube go if inserted too far?
R main bronchus
ABG findings after cardiac arrest
Low pH
Low bicarb
High lactate
Negative base excess
Is sodium bicarbonate recommended for treatment of acidosis post-cardiac arrest?
No
May paradoxically increase intracellular acidosis
Indications are cardiac arrest associated with hyperkalaemia or tricyclic overdose
Which investigations may be indicated post-cardiac arrest?
Coronary angiography
CTPA
CT head
ABG
Bloods - FBC, U&Es, magnesium, bone profile, LFTs
12-lead ECG
CXR - confirm ET tube position, exclude pneumothorax
Echo
Treatment for myocardial dysfunction post-cardiac arrest
Noradrenaline +/- dobutamine
Maintain urine output >0.5ml/kg/hour
Aim for normal or decreasing lactate, MAP over 65 or systolic over 100
How is serum potassium concentration affected by cardiac arrest? How should this be managed?
Initially hyperkalaemia then hypokalaemia
Maintain potassium 4-4.5 to prevent ventricular arrhythmias - give potassium if required
Should patients be sedated post-cardiac arrest?
Not recommended routinely
Can allow for optimal treatment of hypothermia - prevent shivering
Most common seizure type post-cardiac arrest
Myoclonus most common, often generalised but may be focal or multifocal
Can also have focal and generalised tonic-clonic seizures
Often multiple seizure types
Seizures as prognostic indicator post-cardiac arrest
Poor prognosis
How should post-cardiac arrest seizures be managed?
Use EEG to detect seizure activity
Treat with keppra/sodium valproate
No evidence for prophylactic treatment with anti-epileptic drugs
Glucose control post-cardiac arrest
Maintain between 4-10
Temperature management post-cardiac arrest
Monitor core temp after arrest
Hyperthermia common and poor prognostic feature
Prevent hyperthermia - cooling
How common is death due to neurological withdrawal of treatment after cardiac arrest?
Cause of death in 2/3 out-of-hospital arrest and 25% in-hospital
How can prognosis be determined post-cardiac arrest?
Usually not reliable until >72 hours
Clinical exam - pupillary reflexes, corneal reflex, GCS score, seizures
Neurophysiological studies - EEG
Biochemical markers - neuron-specific enolase
Imaging studies - CT/MRI
Graft survival in donors who have had CPR vs not
Similar graft survival at 1 year
