Managing the post-resuscitation patient in the field.
The principal goal after successful resuscitation of a cardiac arrest patient is to maintain the patient's pulse and avoid a pulseless state. Of equal importance in the post-resuscitation patient are efforts to prevent myocardial dysfunction and increase the likelihood of a good neurologic outcome. To optimize cardiac and hemodynamic resuscitation, paramedics should obtain good background information, which could provide clues to factors contributing to the cardiac arrest, such as the use of certain drugs or being overdue for dialysis, and could aid in customizing therapy for rhythm disturbances and hemodynamic aberrations. Treatment of rhythm disturbances depends on the type of arrhythmia identified, the history of present illness, and the resuscitation efforts provided. Common post-resuscitation dysrhythmias are wide-complex tachycardia, narrow-complex tachycardia, and bradycardia. Optimizing neurologic resuscitation is difficult, but evidence suggests that hypertensive reperfusion, hemodilution, and mild hypothermia may be of benefit in improving neurologic outcome after resuscitation. Unfortunately, to date, no proven therapies are available to improve neurologic outcome after resuscitation from cardiac arrest.
Persse
David E
DE
Department of Emergency Medicine, University of Texas-Houston Medical School, and EMS, City of Houston, USA. david.persse@cityofhouston.net
Zachariah
Brian S
BS
Wigginton
Jane G
JG
D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000628:therapy; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D002493:Central Nervous System Diseases / Q000209:etiology* / Q000628:therapy; D006438:Hemodilution; D006801:Humans; D006985:Hyperventilation; D007036:Hypothermia, Induced; D009203:Myocardial Infarction / Q000628:therapy*; D015427:Reperfusion Injury / Q000209:etiology* / Q000628:therapy