Post resuscitation care

5,102 views

Published on

Published in: Health & Medicine
0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
5,102
On SlideShare
0
From Embeds
0
Number of Embeds
9
Actions
Shares
0
Downloads
193
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide
  • Protease enzym that conducts proteolysis. (Breaks down protein, starves the cells)Free radicals are molecules with unpaired electrons. In their quest to find another electron, they are very reactive and cause damage to surrounding molecules.
  • 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 />

    ×