Integrated post-cardiac arrest care is now the 5th link in the AHA adult chain of survival. Topics of focus for post-cardiac arrest care include (TTM) Targeted Temperature Management, hemodynamic and ventilation optimization, immediate coronary reperfusion with PCI (percutaneous coronary intervention), glycemic control, neurologic care and other technical interventions.

• Acls Provider Manual 2017 For Sale
• Acls Provider Manual Isbn

To be successful, post-cardiac arrest care requires an integrated multidisciplinary approach. For the purposes of this site, the review of post-cardiac arrest care interventions will focus primarily on immediate post-arrest interventions and aspects that you will most likely be tested on. For a complete review of the subject refer to your AHA provider manual. (pages: 19-20 and 145-152) (TTM) Targeted Temperature Management TTM which was previously called therapeutic hypothermia is the only intervention that has been shown to improve neurological outcomes after cardiac arrest.

Induced hypothermia should occur soon after ROSC (return of spontaneous circulation). The decision point for the use of therapeutic hypothermia is whether or not the patient can follow commands. (lack of meaningful response to verbal commands) One of the most common methods used for inducing therapeutic hypothermia is a rapid infusion of ice-cold (4° C), isotonic, non-glucose-containing fluid to a volume of 30 ml/kg. The optimum temperature for therapeutic hypothermia is 32-36 ° C (89.6 to 96.8 ° F). A single target temperature, within this range, should be selected, achieved, and maintained for at least 24 hours. During induced TTM, the patient’s core temperature should be monitored with any one of the following: esophageal thermometer, a bladder catheter in the nonanuric patients, or a pulmonary artery catheter if one is already in place.

Axillary and oral temperatures are inadequate for monitoring core temperatures. Ventilation Optimization During the post-cardiac arrest phase, inspired oxygen should be titrated to maintain an arterial oxygen saturation of ≥ 94%. This reduces the risk of oxygen toxicity. Excessive ventilation should also be avoided because of the potential for reduced cerebral blood flow related to a decrease in PaCO2 levels. Also, excessive ventilation should be avoided because of the risk of high intrathoracic pressures which can lead to adverse hemodynamic effects during the post-arrest phase. Quantitative waveform capnography can be used to regulate and titrate ventilation rates during the post-arrest phase. Visit the link for more details about.

Avoid excessive ventilation. Ventilation should start at 10/min and should be titrated according to the target PETCO2 of 35-40 mmHg. Hemodynamic Optimization Hypotension, a systolic blood pressure. Your instructor is correct. This change was overlooked when we updated to the latest AHA ACLS guidelines.

Acls Provider Manual 2017 For Sale

Thank you for pointing this out. I have updated the information for correction. Here is the AHA position: “Healthcare providers should not attempt to alter glucose concentration within a lower range (80-100 mg/dL), because of the increased risk of hypoglycemia. The 2015 AHA guidelines update for CPR and ECC does not recommend any specific target range of glucose management in adults with ROSC after cardiac arrest.” My apologies for the confusion on the post-cardiac arrest glycemic control measures. Kind regards, Jeff. “MAP, or mean arterial pressure, is defined as the average pressure in a patient’s arteries during one cardiac cycle. It is considered a better indicator of perfusion to vital organs than systolic blood pressure (SBP).

A true MAP can only be determined by invasive monitoring and complex calculations; however, it can also be calculated using a formula of the SBP and the diastolic blood pressure (DBP).” The simple way to estimate the patient’s MAP is to use the following formula: MAP = (2 x diastolic) + systolic divided by 3. Revised isa study guide. The reason that the diastolic value is multiplied by 2, is that the diastolic portion of the cardiac cycle is twice as long as the systolic. Ref: Kind regards, Jeff.

Question 1: One of the most common methods used for inducing therapeutic hypothermia is a rapid infusion of ice-cold (4° C), isotonic, non-glucose-containing fluid to a volume of 30 ml/kg. The optimum temperature for therapeutic hypothermia is 32-36 ° C (89.6 to 96.8 ° F). A single target temperature, within this range, should be selected, achieved, and maintained for at least 24 hours. This specific temperature selection within the range of 32-36 ° C, allows for tight control of the temperature. Question 2: Achieving hemodynamic stability, normoglycemia, and TTM all work together to preserve and reestablish normal neurologic function.

Acls Provider Manual Isbn

Question 3: If there is no availability to monitor waveform capnography, good chest rise and fall and maintenance of an adequate airway are the two best methods for ensuring that adequate ventilation’s are being provided. Kind regards, Jeff.