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Post resuscitation care

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Post resuscitation care

  1. 1. Post Resuscitation Care<br />By Kane Guthrie<br />
  2. 2. Objectives<br />Case study<br />Understand post-resuscitation care<br />Look at therapeutic hypothermia<br />
  3. 3. Cardiac Arrest the Stat’s<br />Generally 6-7% survival rate (worldwide)<br />0nly 3-4% leave hospital with RONF<br />Early Defib/compressions make the difference<br />Post resuscitation care is the answer to improving mortality and morbidity with ROSC. <br />
  4. 4. The New Guidelines!!<br />
  5. 5. Case Study<br />68 male walking home from pub<br />Collapse > Cardiac Arrest >Bystander CPR<br />SJA arrive 13mins post arrest<br />In VF, Successful ROSC post x3 defibs<br />Arrives in T2 20 mins later with no RONF<br />What should we do now?<br />
  6. 6. Post Resuscitation Care<br />What is it?<br />Where does it start?<br />Why is it done poorly?<br />What is Post Cardiac Arrest Syndrome?<br />What is Therapeutic Hypothermia?<br />
  7. 7. Post Cardiac Arrest Syndrome!!<br />Thought to be RT production of free radicals<br />Pathophysiology is very complex = BORING<br />Hypoperfusion & Ischaemia cause cascade of events<br />
  8. 8. The Big 4 in Postcardiac Arrest Syndrome<br />
  9. 9. Therapeutic Hypothermia<br />‘Induced hypothermia” is were pt is deliberately cooled between 32-33.9°C<br />It aims to reduce hypoperfusion (& reperfusion) injury post arrest.<br />Focuses mainly on brain (neuroprotection), but offers protection to heart, liver, kidneys.<br />Current research shows benefit of inducing TH before or during event.<br />
  10. 10. Therapeutic Hypothermia<br />Therapeutic hypothermia is the first treatment that has proven effective for post-resuscitation reperfusion injury.<br />NNT 1:6 vs 1:42 for aspirin in STEMI<br />
  11. 11. Who’s up for it?<br />Cardiac arrest with ROSC <br />Persistent significant altered level of consciousness<br /><12 hours from time of ROSC<br />Patients >18 years<br />
  12. 12. Who’s on the Fence?<br />Relative:<br />Persistent hypotension (MAP <60, SBP<90) despite use of inotropes and vasoconstrictors <br />Note:<br />Hypothermia will cause vasoconstriction<br />And help ∧BP<br />
  13. 13. Who’s not?<br />Advanced directive stipulating DNR (absolute)<br />Traumatic arrest<br />Active bleeding (including intracranial)<br />Pregnancy, recent major surgery, severe sepsis<br />
  14. 14. What are the 3 Phase’s of TH?<br />Induction<br />Aim reduce core temp 32-34°C (within 6 hours, preferably 2 hours)<br />Maintenance<br />Maintain core body temp for 12-24<br />Rewarming <br />Either controlled or passive rewarming to normothermia 37°C<br />0.2-0.5°C per hour –over 8-12 hours<br />
  15. 15. ED Management<br />
  16. 16. Cooling Methods<br />Cold saline (during arrest & post arrest)<br />ICE Packs (axilla, groin) <br /><ul><li> Keep pt dry
  17. 17. Monitor skin integrity</li></ul>Machine (Vest, Artic Ice)<br />
  18. 18. What you need<br />Patient airway secured (sedated & paralyzed)<br />ICE and bags<br />Cold saline<br />12 lead ECG<br />Artline<br />NGT<br />IDC<br />Rectal probe<br />?CVC<br />
  19. 19. ED Management<br /><ul><li>Prepare patient for T/F to ICU, Cath Lab</li></li></ul><li>Monitoring the bloods<br />
  20. 20. Remember the basics<br />Pressure area care<br />VTE prophylaxis<br />Stress ulcer prophylaxis<br />Lung protective ventilation<br />Nutrition<br />Social support (family)<br />
  21. 21. Complications<br />Tachycardia > bradycardia<br />Hypertension<br />Diuresis (hypovolaemia)<br />Shivering (increases temp)<br />Arrhythmia's<br />Increase bleeding<br />Spiking temp’s look for signs of infection<br />
  22. 22. Questions<br />
  23. 23. Thank-You<br />