chapter 7 : Postresusciation Management Postresusciation management occurs once the child’s health is under proper control and return of spontaneous circulation is achieved. The posresusciation method assesses the following organ system to ensure proper treatment techniques are applied for adequate management and recovery of the child.
VIDEO
Optimizing Recovery With Post-Resuscitation Care
The organ systems in the postresusciation methods are as follows:
Cardiovascular
Gastrointestinal
Hematologic
Neurologic
Renal
Respiratory
Shock
VIDEO
Neurological Assessment in Post-Resuscitation Care
Cardiovascular
Monitor
Heart rate and rhythm Blood pressure Spo2 Urine output
Physical Examination
Quality of central and peripheral pulses, HR, temperature and color Monitor end-organ function
Lab Test
Arterial blood gas Hemoglobin and hematocrit Serum glucose, electrolytes, BUN/creatinine, Calcium Lactate and central venous oxygen saturation
Non Lab Tests
Chest x-ray to check ET tube insertion, heart size, pulmonary edema, etc 12-lead ECG Echocardiogram
Intravascular Volume
Get vascular access Give fluid boluses of 10 to 20 mL/kg of isotonic crystalloid over 5 to 20 minutes Blood administration Maintain fluid
Blood Pressure
Treat hypotension with vasoactive drugs Treat arrhythmia if hypotension is due to that Give vasopressor for vasodilation induced hypotension
Tissue Oxygenation
Give supplementary oxygen Support perfusion Maintain hemoglobin concentration Targeted temperature management to achieve ROSC normal paCO2 35-45 mmHg
Metabolic Demand
Pain control with morphine or fentanyl Agitation control with sedation Fever maintenance with antipyretics ET tube and ventilation to control breathing
Arrhythmias
Tachyarrhythmias and bradyarrhythmias with medicine and cardioversion Expert consultation
Postarrest Myocardial Dysfunction
Postarrest myocardial dysfunction for 4 to 24 hours after ROSC Vasoactive agents to fix hemodynamic functions Maintain blood pressure and perfusion
Gastrointestinal
Monitor
Monitor type and quality of nasogastic tube drainage
Physical Exam
Abdominal examination and check for bowel sounds, girth and tightness
Lab Tests
Liver function by ALT/AST, albumin, PT/PTT, bilirubin, glucose, ammonia, etc tests Pancreatic function by amylase/lipase tests
Non Lab Tests
Ultrasound to check liver, gall bladder, pancreas and bladder Abdominal CT scan to check for trauma
Gastric Distention
Put in orogastric or NG gupe to aspirate stomach air and contents Inseart NG feeding tube
Ileus
Put in OG or NG to aspirate gastric fluids and contents Maintain electrolyte and fluid balance
Hepatic Failure
Administer glucose Correct clotting factor and use fresh frozen plasma for bleeding
Hematologic
Physical Examination
Find cause of external or internal hemorrhage Check skin for pallor, petechiae or bruising
Lab Tests
Hemoglobin and hematocrit Platelet count Prothrombin time,PTT, INR, fibrinogen, and D-dimer
Neurologic
Monitor
Check and control temperature
Physical Examination
Conduct neurologic assessment by checking pupil response, gag reflex, corneal reflex, etc Check for cerebral herniation Identify seizures Check normal and abnormal movements and neurologic findings
Lab Tests
Check glucose levels Check serum electrolyes and calcium concentration Check for overdosage and poisons Conduct cerebral spinal fluid studies
Non Lab Tests
CT scan EEG for convusions or epileptic seizures
Brain Perfusion
Support cardiac output and oxygen Avoid hyperventilllation
Blood Glucose
Treat hypoglycemia Check glucose concentration Treat hyperglycemia
Temperature Control
Control hypothermia and hyperthermia. Emphasis on targeted
Increased ICP
Head in midline Ventilate Give steroids for inflammation or CNS tumor Use mannitol or saline for herniation
Seizures
Treat seizures with benzodiazepine, fosphenytoin/phenytoin or barbiturate Correct metabolic causes Check for toxins or other diseases
Renal
Monitor
Check for decreased urine output (<1 mL/kg per hour in infants and children) Check for increased urine output due to glucosuria or DI
Physical Examination
Check abdomen for distended bladder or tight abdomen Check for hypovolemia Check urinary catheter placement
Lab Tests
Check renal function by BUN/creatining and serum electrolytes Get urinalysis Assess metabolic state by ABG, glucose, anion gap and lactate concentration
Renal Function
Resore intravsasuclar volume and systemic perfusion with vasoactive drugs Administer loop diuretics to those with volume overload and CHF Put KCL to IV fluids if renal function is poor or no urine output
Acid-base Balance
Fix lactic acidosis with vasoactive agents and improving tissue perfusion Fix non-anion gap with sodium bicarbonate
Respiratory
Monitor
Spo2 and heart rate by pulse oximetry Heart rate and rhythm Exhaled CO2 by colorimetric device Check intubation
Physical Examination
Check chest rise and auscultation of abdomen and breath sounds Check for tachypnea, agitiation, difficulty in breathing, cyanosis, and poor gas exchange
Lab Tests
Get arterial blood gas (ABG)
Non Lab Tests
Get chest x-ray for check for any pulmonary problems and placement of ET tube
Oxygenation
Give oxygen and check for Spo2 ≥ 94-99% If less than 94% give additional ventilation support
Respiratory Failure
ET intubation Gastric tube insertion to eliminate gastric contents
Analgesia and Sedation
Control pain with fentanyl or morphine Sedation with lorazepam or midazolam
Neuromuscular Blockade
For intubated children give becuronium and pancuronium or other neuromuscular blocking agents
Shock
The following algorithm displays PALS postresusciative methods for shock:
