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. 

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