chapter 13- post resuscitation care

Question 1

what are the 4 post cardiac arrest syndromes?

Answer 1

post cardiac arrest brain injury
post cardiac arrest myocardial dysfunction
systemic ischaemia/reperfusion response
persistent precipitating pathology

Question 2

what is the algorithm for adult post-resuscitation care?

Answer 2

1) airways and breathing - give high flow O2, monitor sats, waveform capnography, insert tracheal tube
2) circulation - monitor BP + HR, give 500ml crystalloid fluid, 12 lead ECG, ART line
3) control temp - constant temp to 32-36 degrees + sedation to control shivering
4) decide - likely cardiac cause or not?

5) if YES - angio + PCI
6) admit to ICU
7) ICU management

8) if NO - CT head/CTPA + treat non-cardiac cause
9) admit to ICU
10) ICU management

11) secondary prevention i.e. ICD insertion, screen for genetic disorders etc.

Question 3

what is the ICU management in adult post-resuscitation car algorithm?

Answer 3

temperature control to 32-36 degrees + sedation to control shivering for > 24hrs 
prevent fever for 72 hrs
ECHO
maintain normoglycaemia
control BP - avoid hypotension 
diagnose/treat seizures +/- EEG
avoid prognostication for 72hrs

Question 4

what is a common blood gas finding after cardiac arrest resuscitation?

Answer 4

mixed respiratory and metabolic acidosis - due to intra-arrest hypoventilation and poor tissue perfusion

Question 5

what is each part of the GCS?

Answer 5

eye opening: 
spontaneously - 4
to voice - 3
to pain - 2
nil - 1

verbal: 
spontaneous - 5
confused - 4
inappropriate words - 3
incomprehensible sounds - 2
nil - 1

best motor response: 
obeys commands - 6
localises - 5
normal flexion - 4
abnormal flexion - 3
extension - 2
nil -1

Question 6

how is targeted temperature management achieved?

Answer 6

3 stages: induction, maintenance, rewarming

Question 7

what are the methods of inducing/maintaining temperature management?

Answer 7

simple ice packs
cooling blankets/pads
water or air circulating blankets
ECMO

Question 8

what are some physiological effects and complications of hypothermia?

Answer 8

shivering
mild hypothermia increases systemic vascular resistance and cause arrhythmias (bradycardia)
diuresis which leads to hypophosphataemial hypokalaemia, hypoMg
hyperglycaemia - hypothermia causes reduced insulin sensitivity

Question 9

what are some methods use to assess prognosis after 72hrs?

Answer 9

clinical examination - GCS, pupillary response, corneal reflex, presence of seizures
SSEPS/EEG
imaging - CT brain, MRI
biochemical markers - neruon specific enolase most commonly used

Question 10

what are some risks with bag-mask ventilation?

Answer 10

gastric insufflation, respiratory compromise, regurgitation of stomach contents

Question 11

what is the ATMIST method of handover?

Answer 11

used by AMS -

Age
Name
Time of onset
medical history
investigtions
vital signs
treatment

Question 12

what is the SPIKES model for breaking bad news?

Answer 12

Setting up
Perception - check the patient/relatives perception of the situation by prompting the news regarding illness
Invitation - determine how much information is known already
Knowledge
Emotions with empathy
Summary - summarise and establish a strategy for support

Question 13

what’s the STOP algorithm for debriefing?

Answer 13

Summarise the case
Things that went well
Opportunities to improve
Points of action