Post CPR support

Objectives
To understand
 need for further assessment and
management of patients following CPR
 how to decide which is the most
appropriate place for definitive care and
how the patient should get there
 how to assess and manage common
problems that may develop in post
resuscitation period
 Introduction
The aim of the treating cardiac arrest victims
is to enable them to return their previous
life style without any additional incapacity.
Ideally the victim should have :

Normal Conscious level

No neurological deficit
A stable Cardiac rhythm
Adequate Organ perfusion
 Post Resuscitation Phase

A full assessment of the patient

Management of immediate problems
Deciding whether the patient should go
and how
Care on cardiac or intensive care unit
Patient assessment

During transport A, B, C should be maintained.

Factors affecting the post resuscitation period:

The victims general health

The time delay before resuscitation commenced
The duration of resuscitation phase
The cause of cardiac arrest
 History

Victims previous status of health

Post medical history
Drug History
 b) Examination

1) Respiratory system
• whether the patient can maintain airway or not
• whether oropharyngeal or endotracheal tube
present in situ with or without patient`s
discomfort
• rate and depth of tidal volumes and the
associated consequences
 examination contd.

2) Cardiovascular system
• pulse – rate, rhythm, volume
• BP- maintained or not with or without drugs
• cyanosis

3) Renal system
• urine output – satisfactory or not
• urine examination- clue for renal involvement
present or not
4) CNS
• Glasgow coma scale
• pupil size and reaction
• limb tone and movement and abnormal
posturing
 The Glasgo Coma Scale
Eye opening (E) Spontaneously 4
To commands 3
To pain 2
Nil 1
Verbal (V) Orientated 5
Confused 4
Inappropriate words 3
In comprehensible sounds 2
Nil 1
Best motor response Obeys commands 6
Localises to pain 5
Withdraws from pain 4
Abnormal flexion to pain 3
Extension to pain 2
Nil 1
 Patients in coma have a GCS score of 7 or less Fail to to obey
5) Abdomen
• distension – present or not
• peristaltic sound

C) Monitoring
• ET – CO2
• pulse oximeter
• ECG
• BP monitor
• Urinary catheter
• nasogastric tube
D) Investigations
• X- ray chest
• blood test- urea, electrolytes, glucose, full
blood count
• ABG
• 12 lead ECG
 Immediate post resuscitation care
1) Respiratory care
 the endo tracheal tube can be removed and
the patient allowed to breath spontaneously
 the patient may be allowed spontaneously with
ET in situ
 the patient may be ventilated with ET in situ
2) Neurological Care
 Drug generally used – anti convulsant with
sedation
e.g. diazepam, Midazolam, TPS
 Opiods
 Muscle relaxants – rarely used

3) CVS
 Anti dysarrhythmic drugs
 Antihypertensive drugs
 Thrombolytic and anticoagulants
 Patient transfer

 Where the patient should go

CCU

If They can
• Protect their own Airway
• Spontaneous breathing Adequately
• Have stable Cardiac Rhythm
 ICU
If the Victim does not recover consciousness
Severe Lung Injury
Gross haemodynamic instability

 How should the patient get there

• With all possible connections for monitoring equipments
• Catheters, tubes ,drains
 Care of the CCU patients

Fully investigated to detect cause and

definitive treated can be Commenced.
 Care of the ICU patients
Fully investigated to detect cause and
definitive treated can be Commenced

Care of the ICU patients is mostly supportive

 Care of Nervous system
 Respiratory system
 Cardiovascular system
 Urinary System
 Audit

The management and outcome of all

cases of cardio-respiratory arrest must be
recorded and audited if standards of care
are to be improved.
 Summary
The return of spontaneous cardiac output
following resuscitation must be followed by a full
assessment & investigation of the victim.
These victim will then need to be transported
safely to the most appropriate place for definitive
care.
Those who have made an apparently full
recovery should be managed on the cardiac
care unit.
In contrast , patients with evidence of impaired
organ function will need the resources of an
intensive care unit.
THANK YOU