23 - Post–cardiac arrest care

Summary

This chapter talks about the management of post-cardiac arrest care. It discusses the special circumstances in which adequate hemodynamic stability cannot be achieved during post-cardiac arrest care. An immediate assessment of a patient after the return of spontaneous circulation should include a focused history (usually obtained from bystanders or emergency medical services personnel), physical examination, diagnostic testing, and imaging studies. The physical examination should follow the ABCs, checking the airway for appropriate endotracheal tube (ETT) placement, the presence of bilateral breath sounds, circulatory status and blood pressure, heart rate and rhythm, disability with neurological response and Glasgow coma scale, and exposure to fully expose the patient and complete the examination. The extent of brain injury and cardiovascular instability are the major determinants of mortality after cardiac arrest. Brain injury is responsible for mortality in 68% of out-of-hospital arrests and 23% of in-hospital arrests.