Post-resuscitation care
As an ambulance physician you have been treating a patient after cardiac arrest. 55-year-old man collapsed while jogging, telephone-assisted CPR took 10 minutes, ALS by the ambulance crew took 5 minutes. Initial heart rhythm had been VF. ROSC with sinus rhythm appeared after delivering the second shock. You intubated the patient, you have been monitoring his vital functions and you are about to transport him to ED. What are your next steps?
Help
We set protective ventilation using an air/oxygen mixture – tidal volume 6 mL/kg with PEEP 5 cm H2O. We want to reach EtCO2 4 kPa, SpO2 94-98 %. Targeted SBP is more then 100 mmHg, to reach this pressure we use norepinephrine and fluids.
We set protective ventilation using an air/oxygen mixture – tidal volume 6 mL/kg with PEEP 5 cm H2O. We want to reach EtCO2 5-6 kPa, SpO2 94-98 %. Targeted SBP is less then 100 mmHg, so we don´t have to affect it.
We set protective ventilation using an air/oxygen mixture – tidal volume 6 mL/kg with PEEP 5 cm H2O with aim to reach EtCO2 5-6 kPa and SpO2 94-98 %. We aim for SBP more themn 100 mmHg, to reach this pressure we use norepinephrine and fluids.
We set protective ventilation using 100% oxygen – tidal volume 8 mL/kg with PEEP 5 cm H2O. We want to reach EtCO2 5-6 kPa, SpO2 99-100 %. Targeted SBP is more then 100 mmHg, to reach this pressure we use norepinephrine and fluids.
55
years
man
RR
12 /min
HR
97 /min
SpO2
93 %
BP
97/67 (77) mmHg
GCS
3
EKG
rythm: sinus
action: regular
frequency: 97 bpm
axis: 60°
PR: 160 ms
QRS: 80 ms
QT: 360 ms
no signs of acute coronary syndrome or pulmonary embolism
Examination
A - OTI
B - symmetrical, alveolar breathing bilaterally
C - viz. monitors
D - GCS(Glasgow Coma Scale) = 3 (1-1-1), isocoric pupils
E - IV cannula in dorsum of the hand, laceration on the head
Glycaemia
Gly
6,7  mmol/L
Glycaemia
Take a sample