Immediate Post-Cardiac Arrest Care Algorithm | ACLS Certification Association

Ajouté : 2026-05-12

[00:00:00]hi everyone so you're working your full arrest and suddenly you get rosk and tidal shoots through the roof you got a pulse now what are we gonna do starting right now [Music] so you have ross return of spontaneous circulation for your full arrest yay what are our priorities now what do we need to be thinking about starting with the airway first thing we're going to start throttling that oxygen back arterial blood gases when they drew po2s post to rest on patients what they found is that a pao2 the partial pressure of oxygen in the arteries if it was greater than 300 was associated with poor outcomes so let's talk about the po2 for a minute a normal blood gas po2 is between 80 and 100.

[00:01:05]give or take the literature you read that's on room air so a predicted po2 should be about five times the fio2 you're giving to the patient so on room air right 21 oxygen five times 20 40 60 80 100 okay i should have a pao2 between 80 and 100.

[00:01:27]if i'm delivering 100 oxygen to the patient what's my predicted po2 500 way too high so as soon as we get roused we're going to start throttling back that oxygen how do you do that in the back of an ambulance spo2 or even in the air you don't have a blood gas machine right there you're going to look at your sats if a pao2 on a blood gas let's say is 150 it's gonna be a hundred percent on your sets if it's 500 it's gonna be a hundred percent on your sets so once your sets hit a hundred percent we have no idea how much further the actual po2 is in the patient so we're going to start throttling back and we're going to use our spo2 to titrate that we want to get our titration between 90 to 98 94 99 but we cannot let it go over a hundred we're gonna start throttling back that oxygen so you gave risk you take them from 100 you cut your flow in half if the stats are still 100 turn the oxygen off yeah turn the oxygen off unless the sass get below 92 then you can put it back on and titrate it to hit that range between 92 and 98 hyperoxemia was associated with very poor outcomes uh with patients post-rust hyperoxemia leads to the release of free radicals and it literally destroys brain cells so we have to throttle back that oxygen check the tube make sure the tube is good make sure it's positioned properly uh the markings on the side of the two of those centimeter markings a good rule of thumb is you should be about three times the et tube size at the teeth what that means is if you have a 7-0 et tube in the patient you should have the markings at about 21 at the teeth that's going to get you right where you want to be at some point not emergently you're going to want to check that cuff pressure because someone slammed air into that respiratory usually have a couple later that's a device that measures the pressure it should be between 15 and 25 millimeters of mercury or centimeters of water pressure whatever they're using but we want to check the pressure in the cuff too and again throttle back that oxygen now as far as ventilating the patient we're going to monitor this and use capnography to titrate our rate and our tidal volume that we're giving to the patient now the textbook says you're going to bag them 10 times a minute no you're going to start at 10 a minute maybe and the reason they say 10 is we don't want to hyperventilate the patient that can reduce blood flow and drop their pressure so no hyperventilation but the only time i'm going to ventilate them exactly at 10 is if ventilating them at 10 breaths a minute gives me a reading of 40 on my cabinography so we want to adjust our ventilations to achieve a cabinography between 35 and 45 40 is right in the middle that's your target so we're bagging them to achieve an end title of 40 we're administering oxygen to achieve an spo2 between 92 98 now your ross patient is waking up they have an et tube in them any human being that has an et tube in them wants that tube out of them so your patient is definitely going to reach up they're going to start grabbing for that tube and they're looking at you scared and you may be thinking we'll just extubate the guy it looks good probably not a great choice better and follow your local protocols sedate the patient if we extubate them and they arrest again we're going to have swelling in that back of the airway from the previous intubation it's going to be harder to intubate that patient if we sedate them we keep a secure patient a secure airway in that patient and the sedation is going to help calm them down and help slow the release of catecholamines epinephrine norepinephrine they're releasing because they're all jazzed up and scared because now they're in the back of an ambulance with an et tube stuck in them and they can't breathe sedate them keep them down and uh preserve that airway next we're assessing hemodynamics and we want to try to get their target blood pressure between you know systolic above 90 um or a map greater than 65.

[00:05:49]and remember to calculate a map systolic plus two times the diastole divided by three and that's the pressure we want to maintain how are we gonna get this pressure up well before we start pumping fluids into anybody we're going to assess lung sounds period is this patient already in a state of pulmonary congestion pulmonary edema and if we start giving them fluids we're only going to exacerbate that make it worse and drown the patient so before we start pumping fluids into somebody we're going to listen to lung sounds and you can see throughout the algorithms that we produced any time we're giving fluids there's an icon that reminds you to frequently assess lung sounds uh you can give fluid boluses 200 cc's 500 cc's follow your local protocols for that if we assess lung signs and we got gurgling all through there in pulmonary edema no fluids we're gonna have to go to a presser or an inotrope uh if their pressure is below 90 or less than a map of 65. follow your local protocols dopamine uh leave a fed some places using norepinephrine bumps a lot of people are using now to keep that pressure up all of those are acceptable but again make sure you don't throw them into pulmonary edema next get a 12 lead and you don't want to just have 112 lead because as you're treating the patient that 12 lead is going to change so get an initial 12 lead and that's going to tell you is this patient infarcting do we need to go right to the cath lab do we need to call a cardiac alert in the field to get this patient to the cath lab if they have no signs of it you look at the 12 lead they have no st elevation they have no signs of an acute mi we're still going to call it in and give our report and then bring the patient to the hospital but we need to rule out are they a stemi patient next we're going to look at the patient's neural status and we're asking the question can the patient follow commands or not they may be intubated you may have actually sedated them but if you say raise your right hand and that intubated sedation sedated patient raises their right hand they're able to follow commands super groovy if the patient cannot follow commands to help preserve their neural status after us we're going to begin targeted temperature management and this therapy has been shown to improve neural outcomes the goal is to cool the body to a temperature between 32 and 36 degrees celsius for at least 24 hours and that's a core temperature okay so no thermal scans up here this is a foley tap rectal temp it needs to be a core temperature okay now the items i went through in this algorithm they're not linear these are all done pretty much in concert at the same time by a high performance team you need to practice these things everybody needs to know what's going on and review these algorithms frequently okay this has been just a quick review of the posterest rosk algorithm i'm mark thanks for watching see in the next [Music]