University:
American Career College
Course:
NURS-113 | Beginning Medical/Surgical Nursing
Academic year:

2020
Views:

274

Pages:

1
Author:

Leilani Contreras

Post–Cardiac Arrest Care Algorithm Initial Stabilization Phase ROSC obtained Resuscitation is ongoing during the post-ROSC phase, and many of these activities can occur concurrently. However, if prioritization is necessary, follow these steps: Manage airway Early placement of endotracheal tube • Airway management: Waveform capnography or capnometry to confirm and monitor endotracheal tube placement • Manage respiratory parameters: Titrate Fio2 for Spo2 92%-98%; start at 10 breaths/min; titrate to Paco2 of 35-45 mm Hg • Manage hemodynamic parameters: Administer crystalloid and/or vasopressor or inotrope for goal systolic blood pressure >90 mm Hg or mean arterial pressure >65 mm Hg Manage respiratory parameters Start 10 breaths/min Spo2 92%-98% Paco2 35-45 mm Hg Initial Stabilization Phase Manage hemodynamic parameters Systolic blood pressure >90 mm Hg Mean arterial pressure >65 mm Hg Obtain 12-lead ECG Continued Management and Additional Emergent Activities Consider for emergent cardiac intervention if • STEMI present • Unstable cardiogenic shock • Mechanical circulatory support required These evaluations should be done concurrently so that decisions on targeted temperature management (TTM) receive high priority as cardiac interventions. Follows commands? Continued Management and Additional Emergent Activities No • • • • Comatose TTM Obtain brain CT EEG monitoring Other critical care management Yes Awake Other critical care management Evaluate and treat rapidly reversible etiologies Involve expert consultation for continued management • Emergent cardiac intervention: Early evaluation of 12-lead electrocardiogram (ECG); consider hemodynamics for decision on cardiac intervention • TTM: If patient is not following commands, start TTM as soon as possible; begin at 32-36°C for 24 hours by using a cooling device with feedback loop • Other critical care management – Continuously monitor core temperature (esophageal, rectal, bladder) – Maintain normoxia, normocapnia, euglycemia – Provide continuous or intermittent electroencephalogram (EEG) monitoring – Provide lung-protective ventilation H’s and T’s Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypokalemia/hyperkalemia Hypothermia Tension pneumothorax Tamponade, cardiac Toxins Thrombosis, pulmonary Thrombosis, coronary