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EMS A to Z: Post-Resuscitation Care
EMS A to Z: Post-Resuscitation Care
Show Notes:
From your hosts, Dr. Josh Gaither, Dr. Amber Rice, and Dr. Rachel Munn
What is the best next step to take once identifying a cardiac arrest patient has ROSC?
Hemodynamic support: Patients with ROSC are typically in “shock” with unstable vital signs, hypotension, hypoxia, etc. Obtaining vitals and identifying how to support the patient’s hemodynamics is key.
IV fluids
Dopamine: Dosing range is 5 – 20mcg/kg/min --> There are a number of ways taught to dose dopamine (the clock method, etc.). As an example, if you choose to start your dose at 10mcg/kg/min, in a 80kg person that’s 800mcg/min. If your concentration is 1600mcg/mL (standard), then that’s 0.5mL/min or 30 drops / min if you’re using 60cc tubing.
Dopamine is incredibly titratable. Keeping 30 drops a minute (1 drop every 2 seconds) in the back of your mind is a great starting point for *most* patients, and you can increase / decrease based on BP from there.
The key is starting dopamine early! Most of these patients will still have a little epi circulating and can crash precipitously when that wears off if another vasopressor hasn’t been started.
What are other considerations for evaluation / treatment?
ECG: A post-ROSC ECG can help identify a STEMI, which may change your transport destination.
Airway: A functional iGel / SGA can stay in place. Support respirations with BVM in sync with patient’s breathing to the best of your ability.
ETCO2: Monitoring ETCO2 can clue you in to an airway displacement, or hemodynamic compromise indicating impending re-arrest.
CAUSES: Of course we’re thinking about causes during the arrest, but don’t forget to consider things like hypothermia, renal failure / hyperkalemia, etc. That treatment could be initiated in the prehospital setting.
Are there things we’re NOT doing for ROSC patients now?
Therapeutic Hypothermia: Now our goal is largely to prevent fever.
Music by lemonmusicstudio from Pixabay
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By EMSAtoZ
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EMS A to Z: Post-Resuscitation Care
Show Notes:
From your hosts, Dr. Josh Gaither, Dr. Amber Rice, and Dr. Rachel Munn
What is the best next step to take once identifying a cardiac arrest patient has ROSC?
Hemodynamic support: Patients with ROSC are typically in “shock” with unstable vital signs, hypotension, hypoxia, etc. Obtaining vitals and identifying how to support the patient’s hemodynamics is key.
IV fluids
Dopamine: Dosing range is 5 – 20mcg/kg/min --> There are a number of ways taught to dose dopamine (the clock method, etc.). As an example, if you choose to start your dose at 10mcg/kg/min, in a 80kg person that’s 800mcg/min. If your concentration is 1600mcg/mL (standard), then that’s 0.5mL/min or 30 drops / min if you’re using 60cc tubing.
Dopamine is incredibly titratable. Keeping 30 drops a minute (1 drop every 2 seconds) in the back of your mind is a great starting point for *most* patients, and you can increase / decrease based on BP from there.
The key is starting dopamine early! Most of these patients will still have a little epi circulating and can crash precipitously when that wears off if another vasopressor hasn’t been started.
What are other considerations for evaluation / treatment?
ECG: A post-ROSC ECG can help identify a STEMI, which may change your transport destination.
Airway: A functional iGel / SGA can stay in place. Support respirations with BVM in sync with patient’s breathing to the best of your ability.
ETCO2: Monitoring ETCO2 can clue you in to an airway displacement, or hemodynamic compromise indicating impending re-arrest.
CAUSES: Of course we’re thinking about causes during the arrest, but don’t forget to consider things like hypothermia, renal failure / hyperkalemia, etc. That treatment could be initiated in the prehospital setting.
Are there things we’re NOT doing for ROSC patients now?
Therapeutic Hypothermia: Now our goal is largely to prevent fever.
Music by lemonmusicstudio from Pixabay