Cardiac arrest resuscitation

[dave3189]

I am a newly certified Basic and have a question regarding the presentation of a patient who is resuscitated after VT/VF with CPR and defib. I don't recall this being discussed in my course. I would imagine that LOC doesn't change much initially but vitals do? Any help would be appreciated. Thanks all!

[18G]

Honestly, you can see anything when the patient regains a pulse. Most often, the patient will remain in respiratory arrest or with a respiratory status that will require ventilatory support. Chances are the patient will be intubated so they will remain intubated and ventilated.

Vitals can be anything from hypotension to hypertension to bradycardia and tachycardia. What caused the arrest will have some influence on what kinda of vitals you have.

Some patients may regain full consciousness or become combative.

It just all depends.

[redcrossemt]

Originally Posted by dave3189

I am a newly certified Basic and have a question regarding the presentation of a patient who is resuscitated after VT/VF with CPR and defib. I don't recall this being discussed in my course. I would imagine that LOC doesn't change much initially but vitals do? Any help would be appreciated. Thanks all!

Thanks for reposting a separate thread!

It really depends on how long the patient has been without a perfusing rhythm.

I've seen patients wake up if defibrillated early enough. Some of these patients are immediately A&O, and some are confused or combative. Some patients remain very altered or unconscious.

During VT/VF, you will have no pulse and no breathing. If you get ROSC (return of spontaneous circulation), it means you got a perfusing rhythm back. This may not be perfusing all tissues if the heart is damaged, so you might not get a radial pulse back immediately. Also, breathing may not spontaneously return with circulation. As far as blood pressure, there is obviously not one with VF/VT; and there is one in any perfusing rhythm, even if difficult/impossible to auscultate on the arm.

Do you have any specific questions?

[dave3189]

Thanks for the reply. My local protocol calls for CPR to continue even if you get a rythem back in cases where Adults have a syst BP<60 and infants with a HR<60. Is this pretty standard?

[redcrossemt]

Originally Posted by dave3189

Thanks for the reply. My local protocol calls for CPR to continue even if you get a rythem back in cases where Adults have a syst BP<60 and infants with a HR<60. Is this pretty standard?

Infants pulse <60, yes.

Adults BP <60, no. I've actually never heard of this. Once you shock, immediately start CPR again unless there are obvious signs of life (patient starts moving/talking/whatever). After 2 minutes or 5 cycles, you recheck a carotid pulse and stop CPR if they have one.

[dave3189]

In a situation where you shock, then in the case of an AED you are advised not to shock, then palp a BP, is there a range where you would continue CPR because of the low BP? We were taught that <60 is not perfusing and therefore to continue CPR.

[redcrossemt]

Originally Posted by dave3189

In a situation where you shock, then in the case of an AED you are advised not to shock, then palp a BP, is there a range where you would continue CPR because of the low BP? We were taught that <60 is not perfusing and therefore to continue CPR.

1. Defibrillation
2. Immediately resume chest compressions.
3. Continue CPR for 2 minutes / 5 cycles
4. Check breathing - 2 rescue breaths
5. Check carotid pulse - if none, do CPR

No where does the AHA or ARC recommend checking a blood pressure during a cardiac arrest. It's all based on a carotid pulse, which is a much better indicator of perfusion in any person than any auscultated (and especially palpated) BP and associated number given in your class.

If they have a pulse during one of your checks, you would continue your assessment and treatment, including obtaining a blood pressure. You would not start CPR again unless they lost their pulse.

[dave3189]

ok, that makes sense. I'll have to go back and read my notes. They had us doing everything you just said with the exception of what I said. One you had found a carotid pulse and breathing was intact you would then take a BP. They advised however that a BP<60 was not sufficient to perfuse so continue with CPR.

Thanks for your expertise and clarification.

[redcrossemt]

Originally Posted by dave3189

ok, that makes sense. I'll have to go back and read my notes. They had us doing everything you just said with the exception of what I said. One you had found a carotid pulse and breathing was intact you would then take a BP. They advised however that a BP<60 was not sufficient to perfuse so continue with CPR.

Thanks for your expertise and clarification.

No problem. Search this forum regarding palpating blood pressures, and the correlation between systolic pressures and radial-brachial-carotid pulses too. Pretty inaccurate stuff that's carried down through EMS mostly due to tradition, and not very much rooted in evidence-based medicine...

[dave3189]

Will do. This forum is prett awesome! The fact that those less experienced can draw off of people like you is great. It's also admirable that people take the time to help people out like this! Thx again.