Post-cardiac arrest care | ACLS-Algorithms.com

Comments

  1. Robert Kuklok says

    How fast of an infusion of cold iv solution and can this cause fluid overload or work on the heart?

    • Jeff with admin. says

      This would be completely dependent upon the situation. Caution should always be used when giving any type of fluid during the post arrest phase.

      The infusion of cooled saline solution is targeted to a volume of 30 ml/kg and a maximum rate of 100 ml/min to achieve the targeted temperature.

      Kind regards,
      Jeff

  2. GregW says

    Regarding MAP. I find that using a different calculation for MAP is easier to do without paper and pencil (or calculator): ((Systolic-Diastolic)/3) + D. This is: adding 1/3 of the difference between the systolic and diastolic pressures to the diastolic.

  3. Dr Syed Ashraf says

    Hi sir
    your opinion regarding Moderate glycemic control measures should be implemented to maintain glucose levels from 144-180 mg/dL is questioned by one of our ACLS instructor as it is not mentioned in ACLS manual. kindly let me know the reference

    • Jeff with admin. says

      Your instructor is correct. This change was overlooked when we updated to the latest AHA ACLS guidelines. Thank you for pointing this out. I have updated the information for correction.

      Here is the AHA position:
      “Healthcare providers should not attempt to alter glucose concentration within a lower range (80-100 mg/dL), because of the increased risk of hypoglycemia. The 2015 AHA guidelines update for CPR and ECC does not recommend any specific target range of glucose management in adults with ROSC after cardiac arrest.”

      My apologies for the confusion on the post-cardiac arrest glycemic control measures.

      Kind regards,
      Jeff

  4. Ray Taylor says

    In a scenario of post-cardiac arrest, EKG: irregular tachycardia (HR >150) with an unstable BP, should i follow the “unstable tachycardia algorithm” or is there any other special consideration i should keep in mind?

    Thank you in advance

    • Jeff with admin. says

      You would follow the unstable tachycardia algorithm.

      As with any cardiac emergency, you would need to consider any underlying causes and seek expert consultation as soon as possible.

      Kind regards,
      Jeff

  5. Rachel Jolokai says

    Hey Jeff,

    What is the difference between BP and mean arterial pressure? How do you calculate it and when is one more helpful than the other?

    • Jeff with admin. says

      “MAP, or mean arterial pressure, is defined as the average pressure in a patient’s arteries during one cardiac cycle. It is considered a better indicator of perfusion to vital organs than systolic blood pressure (SBP). A true MAP can only be determined by invasive monitoring and complex calculations; however, it can also be calculated using a formula of the SBP and the diastolic blood pressure (DBP).”

      The simple way to estimate the patient’s MAP is to use the following formula: MAP = [ (2 x diastolic) + systolic ] divided by 3. The reason that the diastolic value is multiplied by 2, is that the diastolic portion of the cardiac cycle is twice as long as the systolic.

      Ref:
      1-Calculating MAP

      2-Calculating MAP

      Kind regards,
      Jeff

    • Jeff with admin. says

      there is no particular time frame in terms of the definition for ROSC.

      There are many variables that can affect ROSC. Time is an important factor and a resuscitation team must take this into consideration.

      Probably the most important factor that will affect ROSC and your continuation of CPR will be an adequate end tidal CO2.

      ETCO2 will give you a good gauge of whether your patient can achieve ROSC.

      Kind regards,
      Jeff

  6. Tehetena Zarou says

    Hi Jeff,

    Thanks so much for the valuable information and the excellent presentation.

    A few questions;( hope not too many)
    TTM; How is a single targeted temperature selected and maintained?
    In terms of acheiving hemodynamic stability and maintaining normoglyacaemia ,how does it go hand in hand with TTM?
    Also how best can ventilation be optimised in the abscence of wave capnography
    Kind regards

    • Jeff with admin. says

      Question 1:
      One of the most common methods used for inducing therapeutic hypothermia is a rapid infusion of ice-cold (4° C), isotonic, non-glucose-containing fluid to a volume of 30 ml/kg. The optimum temperature for therapeutic hypothermia is 32-36 ° C (89.6 to 96.8 ° F). A single target temperature, within this range, should be selected, achieved, and maintained for at least 24 hours. This specific temperature selection within the range of 32-36 ° C, allows for tight control of the temperature.

      Question 2:
      Achieving hemodynamic stability, normoglycemia, and TTM all work together to preserve and reestablish normal neurologic function.

      Question 3:
      If there is no availability to monitor waveform capnography, good chest rise and fall and maintenance of an adequate airway are the two best methods for ensuring that adequate ventilation’s are being provided.

      Kind regards,
      Jeff

  7. Jeff with admin. says

    Excessive ventilation causes decreased PaCO2 which subsequently leads to arterial vasoconstriction thus lowering cerebral blood flow (CBF), and cerebral blood volume. This effect is mediated my pH changes in the extracellular fluid which cause cerebral vasoconstriction or vasodilation depending on the pH.

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