ROSC

Question 1

Recognising ROSC

Answer 1

-obvious signs of life
-normal breathing
-colour change
-spike in ETCO2
-pulse present

Question 2

What to do once got ROSC

Answer 2

-after ROSC its common for pt to re-arrest
-therefore required to stay 10mins on scene to stabilise the pt before conveying

Question 3

Post cardiac arrest syndrome

Answer 3

-everything we do post ROSC helps to minimise post arrest syndrome
Includes:
-post arrest brain injury
-post arrest myocardial dysfunction
-systemic ischaemia/ reperfusion response
-persistent precipitating pathology

Question 4

What to do in the 10 minutes post ROSC

Answer 4

-monitor and prepare for re-arrest
-prepare for transfer
-update control- further assistance?
-Response then ABCDE
-pre alert/ transfer

Question 5

What to test in response

Answer 5

-is pt moving/ making noises
-AVPU
-full GCS in disability

Question 6

What to aim for when assessing airway

Answer 6

-patent
-tolerating airway adjunct?
-secure airway for movement
-ETCO2 waveform
-are they maintaining own airway?

Question 7

What to aim for when assessing breathing

Answer 7

-are they breathing/ self ventilating?
-oxygen mask or BVM?
-Normocapnoea- between 4 and 4.5kpa in ROSC
-normal SPO2
-bilateral air entry
-if sats consistent 98-100%, titrate O2 down slowly

Question 8

Ventilation technique

Answer 8

-hypercapnia increases likelihood of further cardiac arrest/ secondary brain injury
-caused by hypoventilation causing high levels CO2 in blood causing resp acidosis and fall in blood pH

-Hyper ventilation leads to low levels CO2 in blood (hypocapnia)
-causes respiratory alkalosis or rise in blood pH

(ONLY FOR ROSC NEVER IN ARREST)
-if ETCO2 high, supply (increase ventilation eg. once every 3 secs)
-if ETCO2 low, slow (decrease ventilation eg. once every 9 secs)

Question 9

What we check when assessing circulation

Answer 9

Pulse (central and peripheral)
-Bradycardic? consider atropine and adrenaline as per bradycardia algorithm
-tachycardic- consider cause, treat underlying cause
Cap refill
-central (forehead) vs peripheral
BP
-hypotensive- 250ml bolus NaCl IV/IO
-if still hypotensive consider adrenaline
12 Lead ECG
-identify and document abnormalities
-if pt meets PPCI criteria contact them to discuss
-consider senior clinical support to manage arrythmias

Question 10

Post ROSC adrenaline

Answer 10

-if hypotensive post ROSC:
1st give 250ml fluid bolus
-still hypotensive? - aged 18+, pulse less than 120bpm
-then give 10mcg aliquot adrenaline every 2 minutes until systolic BP is greater than 100mmHg

Question 11

Administering post ROSC adrenaline

Answer 11

-draw 1ml (1mg=1000mcg) of 1:10,000 adrenaline into 10ml syringe
-dilute with 9ml NaCl to make 10ml of 1:100,000 adrenaline
-syringe now has 100mcg in 10ml
-therefore 10mcg per ml
-ensure label syringe with drug and dose

Question 12

Things to check when assessing disability

Answer 12

Temperature
-aim for core temp 36 if older than 1 and GCS below 10
-allow to passively cool, no more clothing/ blankets than necessary, consider air con if needed
BM
-measure venous sample where possible (from cannula) strong association between hyperglycaemia and poor neurological outcomes
-severe hypoglycaemia is associated with increased mortality
-manage hypoglycaemia using IV 10% glucose as per guidelines
LOC
-GCS
-pupillary response
Seizure
-if seizure post ROSC lats longer than 2-3 minutes or is recurrent and unlikely to be due to hypoxia, administer IV diazepam

Question 13

Things to assess when thinking about exposure/ extrication

Answer 13

-planning and preparation should be simultaneous with ROSC management
-delegate this task to another person on scene
-consider HART/ fire if going to be difficult to extricate
-feet first downstairs if patient needs to be tilted
-30 degree tilt to head end when in ambulance to reduce intercranial pressure
-pre alert- SBAR

Question 14

Record post ROSC bundle

Answer 14

-must record post ROSC care bundle has been given on EPCR by recording:
12 lead ECG
BM
ETCO2
O2
BP
Fluids- where indicated