Through this paper, we have learned to recognize that after recovery of autonomic heart rate (ROSC), hyperoxemia can cause harmful effects; after ROSC, monitor oxygen saturation or pulse oximetry or arterial blood gas analysis is applied. Adjust the concentration of inhaled oxygen to reach an oxygen saturation SaO2 of 94% to 98%. Response and precautions for cardiac arrest caused by a variety of special circumstances.
I. Preamble
It is increasingly recognized that systematic post-cardiac arrest treatment after recovery of the voluntary heart rate improves the quality of life of patients, which is partly attributed to the publication of randomized controlled clinical trials and the elaboration of post-cardiac arrest syndromes. Post-cardiac arrest treatment significantly reduces the mortality rate of early hemodynamic instability, late multi-organ function, functional failure and brain injury with disability. Qiu Zhanjun, Department of Emergency Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine
Second, the initial goal and late goal
The initial goals are, first, optimal cardiopulmonary function and perfusion of vital organs. Second, after out-of-hospital cardiac arrest, the patient should be transferred to a hospital with a comprehensive post-cardiac arrest treatment system, including acute coronary intervention, neurological monitoring and targeted therapy and hypothermia treatment. Third, in-hospital post-cardiac arrest patients should be transferred to an ICU for comprehensive post-cardiac arrest care in hospitals with these capabilities. Fourth, attempts should be made to diagnose and treat the causes of cardiac arrest and to prevent recurrence.
The post-traumatic goals are, first, to control temperature to improve optimal survival and optimal neurological recovery. Second, to diagnose and treat acute coronary syndrome (ACS). Third, optimal mechanical ventilation to reduce lung injury. Fourth, reduce the risk of multi-organ damage and support organ function if necessary. Fifth, objective assessment of the prognosis for recovery . Sixth, to provide rehabilitation services to survivors when needed.
III. Key points of treatment
Diagnostic points and optimal treatment are not known, but advanced CPR points and clinical treatment protocols have been developed, and survival rates are positively correlated with the number of cases treated.
(i) Cardiac arrest – post-treatment process
The cardiac arrest-post-treatment flow (shown in the figure below), optimal ventilation and oxygenation (SaO2 ≥ 94%; intubation and CO2 map; prevention of hyperventilation) after recovery of the voluntary heart rate. Then treat hypotension (SBP <90 mmHg): IV/IO rapid infusion; sedation of antihypertensive drugs; search for reversible etiology; 12-lead electrocardiogram. Then look at compliance with instructions, which actually determines whether the patient has a febrile state of consciousness with or without coma and how well he or she complies with language. If the compliance to language is poor, consider induced hypothermia treatment. For good compliance, if the myocardial infarction is too high in the ST segment or if there is a high suspicion of myocardial infarction, coronary reperfusion is indicated. If not, put the patient on intensive care treatment.
Cardiac arrest – post-treatment. First, ventilation and oxygen therapy: avoid hyperventilation; ventilation frequency 10-12 times/min; adjust oxygen concentration to ensure pulse oxygen concentration, ensure SpO2 ≥ 94%. Second, intravenous fluids: use saline or Ringer infusion, if hypothermia treatment, you can use 4℃ fluid. Third, adrenaline 0.1-0.5ug/kg/min. fourth, norepinephrine 0.1-0.5ug/kg/min. fifth, dopamine 5-10ug/kg/min.
(ii) Clinical treatment plan
The table below shows. Ventilation has four items: carbon dioxide waveform graph, chest radiograph, oxygen saturation and blood gas, and mechanical ventilation. Hemodynamics: monitor blood pressure, preferably arterial blood pressure, and treat hypotension. Cardiovascular problems: monitoring of ECG, troponin, treatment of acute coronary syndrome, echocardiography. Neurological: regular neurological examinations, EEG, core temperature, non-enhanced CT, with sedatives or inotropes. Metabolism: check lactate concentration, blood potassium, urine volume with creatinine, blood glucose, avoid hypotonic fluids. This is the main point of the clinical treatment plan.
Ventilation
Hemodynamics
Cardiovascular
neurological
Metabolism
CO2 waveform graph
Monitoring blood pressure (A)
Monitoring of ECG
Neurological examination
Lactate
Chest radiograph
Treatment of hypotension (boosting drug dose)
Electrocardiogram/troponin
Electroencephalogram
Potassium
SpO2/blood gas
Treatment of ACS
Core body temperature
Urine volume/creatinine
Mechanical Ventilation
Echocardiography
Non-enhanced CT
Blood glucose
Sedation/inositol
Avoid hypotonic fluids