Post-resus care

Following return of spontaneous circulation (ROSC) make sure everyone doesn’t leave; there is still lots to be done

• Assess the patient from an ABCDE perspective
• Airway
  • The patient should by not have an ET tube in place. Ensure a patient airway and aim for normoxia and normocapnia
  • Obtain ABG samples to guide this
• Breathing
  • Ensure sats reasonable (aim over 94%) and titrate oxygen to achieve this
  • Auscultate the chest
  • Obtain a chest radiograph (CXR)
• Circulation
  • Obtain further IV access and bloods as necessary and measure the lactate
  • Continue fluid resuscitation
  • Ausculatate the heart
  • Obtain a 12 lead electrocardiogram (ECG) and beside echo
  • If myocardial infarction (MI) is the suspected cause of cardiac arrest, early percutaneous coronary intervention (PCI) should be considered
• Disability
  • Recheck pupils
  • Measure blood glucose and correct any hyper/hypoglycaemia
  • Control any seizures with benzodiazepines, anti-convulsants or anaesthetic agents such as thiopental
• Exposure
  • Therapeutic hypothermia should be considered for all comatose survivors of cardiac arrest. However, this is a controversial area and should be discussed with the intensive care department.
• Consider whether further resuscitation attempts would be effective or in the patient’s best interests if they were to arrest again; if not then consider a Do Not Attempt CPR (DNACPR) order after discussing the matter with the patient and their loved ones
  • If this is not possible due to a low level of consciousness, a decision will have to be made in their best interests

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