Post-resuscitation care

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Markhk

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One of the things not extensively covered in the current ACLS course or in many county protocols, is post-resuscitation care. What do you personally do after you get a return of spontaneous circulation after V-Fib/V-Tach?

Specifically:

- Do you like to hang an infusion of the anti-arrhythmic that "helped" convert the rhythm?

- Do you aggressively treat hypotension (even if mild) with a fluid bolus or dopamine?

- Do you begin cooling measures to encourage cerebral hypothermia?

- Or do you leave all of these decisions to the ED Staff?
 
Most protocals state that you hang a drip, once you convert. This is to keep pt from converting back to the lethal rhythm.
 
All of the above.................

Amio or Lido drip

Fluid bolus of NS cooled to 36 degrees

Dopamine 5 mcg/kg/min

Ice packs to neck, axilla, and groin

Versed and Vecuronium for shivering
 
Markhk said:
One of the things not extensively covered in the current ACLS course or in many county protocols, is post-resuscitation care. What do you personally do after you get a return of spontaneous circulation after V-Fib/V-Tach?

Specifically:

- Do you like to hang an infusion of the anti-arrhythmic that "helped" convert the rhythm?

- Do you aggressively treat hypotension (even if mild) with a fluid bolus or dopamine?

- Do you begin cooling measures to encourage cerebral hypothermia?

- Or do you leave all of these decisions to the ED Staff?
Click to expand...

We do hang an infusion of the medication that helped to convert the rhythm. Also, if we convert someone from VF or VT to a perfusing rhythm without medication we give a loading dose and start an infusion.

We do treat hypotension with fluids and dopamine if indicated.

We don't have a protocol for inducing hypothermia after an arrest.

Shane
NREMT-P
 
Personally, I prefer to get the blood level up on antiarrhythmic then hang a maintenance level.

I hold off a little while before jumping into aggressive therapy post arrest. I give a little time before bolusing, and Dopamine.. remember the heart just went under some stress. Allow the heart to return to homeostasis. If the hemodynamics do not return within a few minutes, then I do the usual bolus, vasopressors.

No, I do not induce hypothermia... we have a few hospitals that are set up for that, but the jury is still out on research on this.. still very controversial..

R/r 911
 
I wonder what they suggest for those of us who do ILS. I have several cardiac drugs at my disposal (epi, artopine) and I can manually defibrillate. Assuming for a moment we have no medic nearby, what do you all suggest? As I see it once I convert someone to a NSR, keep their airway open and assist with ventilations as needed and manage any hypotension with fluids.
 
bstone said:
I wonder what they suggest for those of us who do ILS. I have several cardiac drugs at my disposal (epi, artopine) and I can manually defibrillate. Assuming for a moment we have no medic nearby, what do you all suggest? As I see it once I convert someone to a NSR, keep their airway open and assist with ventilations as needed and manage any hypotension with fluids.
Click to expand...

Airway, fluid to maintain hemodynamic stability, and get 'em to a hospital. Sounds like its about all you can do....................
 
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