43 Post Cardiac Arrest Care

43.1 Note

Cardiac Arrest
- Work-up
  - Labs:
    - CMP, CBC, PT/INR, PTT
    - Lactate
    - Troponin
    - If concern for sepsis, check BC x2
    - If warranted, beta-hCG to r/o pregnancy
    - After intubation and optimize etCO2: check ABG
  - EKG
  - CXR
    - Confirm airway, r/o PNA, PTX, pulm edema
  - non-constrast head CT
  - Consider pan-scan CT (head, C/A/P) to look for PE or occult foci of bleeding/sepsis
  - Echo/POCUS
    - r/o PTX, eval for tamponade, hypOvolemia, RV failure, eval for peritoneal ascites/blood
  - If concern for PE, consider LE duplex U/S
- Plan
  - If concern for MI, consider ASA, P2Y12 inhibitor, heparin/LMWH. arrange for cath
  - MAP goal > 75 (2010 AHA MAP goal >= 65)
    - Pressors if shock: NE or dobutamine
  - Consider stress dose steroids
  - Supplemental O2
    - Goal sat 94-98% (avoid hyperoxia), PaO2 75-100 mmHg
  - Pulm/Crit consult for intubation/vent mgmt
    - Goal PetCO2 ~35-40 mmHg; Target PaCO2 40-45 mmHg (2010 AHA Guidelines)
  - Keep K > 4, Mg > 2
  - TTM if unconsious/unable to follow verbal commands despite ROSC
    - Not needed if pt is awake or neuro intact
    - Target temp 36 degrees celsius
    - TTM options: cold IV saline, ice, cooling blanket
    - Continuous temp monitor: bladder/esophageal
    - APAP 1,000 mg PO q6h scheduled
  - Multimodal mgmt to control shivering
  - EEG
    - Tx seizures if evidence
  - Consider thorough neuro eval and MRI to assess neurological outcome
  - ppx
    - DVT ppx
    - GI ppx
  - Diet: consider enteral nutrition
    - Nutrition consult for TF recs?
43.2 Manage Shivering during TTM
