Post Resuscitation Care

If a person has a return of spontaneous circulation (ROSC), start post-resuscitation care immediately. The initial PALS process is intended to stabilize a child or an infant during a life-threatening event. Post-resuscitation care is meant to optimize ventilation and circulation, preserve organ/tissue function, and maintain recommended blood glucose levels. Below find a systematic approach followed by a post-resuscitation care algorithm to guide you in your treatment.

RESPIRATORY SYSTEM

• Chest X-ray to verify ET tube placement
• Arterial blood gas (ABG) and correct acid/base disturbance
• Pulse oximetry (continuously monitor)
• Heart rate and rhythm (continuously monitor)
• End-tidal CO2 (if the patient is intubated)
• Maintain adequate oxygenation (saturation between 94% and 99%)
• Maintain adequate ventilation to achieve PCO2 between 35 to 45 mm Hg unless otherwise indicated.
• Intubate if:
  • Oxygen and other interventions do not achieve adequate oxygenation
  • Needed to maintain a patent airway in the child with a decreased level of consciousness
  • Ventilation is not possible through non-invasive means, e.g., continuous positive airway pressure (CPAP)
• Control pain with analgesics and anxiety with sedatives (e.g. benzodiazepines)

CARDIOVASCULAR SYSTEM

• Arterial blood gas (ABG) and correct acid/base disturbances
• Hemoglobin and hematocrit (transfuse or support as needed)
• Heart rate and rhythm (continuously monitor)
• Blood pressure (continuously monitor with arterial line)
• Central venous pressure (CVP)
• Urine output
• Chest X-ray
• 12 lead ECG
• Consider echocardiography
• Maintain appropriate intravascular volume
• Treat hypotension (use vasopressors if needed and titrate blood pressure)
• Pulse oximetry (continuously monitor)
• Maintain adequate oxygenation (saturation between 94% and 99%)
• Correct metabolic abnormalities (chemistry panel)

NEUROLOGICAL SYSTEM

• Elevate head of bed if blood pressure can sustain cerebral perfusion
• Temperature
  • Avoid hyperthermia and treat fever aggressively
  • Do not re-warm hypothermic cardiac arrest victim unless hypothermia is interfering with cardiovascular function
  • Treat hypothermia complications as they arise
• Blood glucose
  • Treat hypo/hyperglycemia (hypoglycemia defined as less than or equal to 60 mg/dL)
• Monitor and treat seizures
  • Seizure medications
  • Remove metabolic/toxic causes
• Blood pressure (continuously monitor with arterial line)
• Maintain cardiac output and cerebral perfusion
• Normoventilation unless temporizing due to intracranial swelling
• Frequent neurological exams
• Consider CT and/or EEG
• Dilated unresponsive pupils, hypertension, bradycardia, respiratory irregularities, or apnea may indicate cerebral herniation

RENAL SYSTEM

• Monitor urine output
  • Infants and small children: > 1 mL/kg an hour
  • Larger children: > 30mL an hour
  • Exceedingly high urine output could indicate neurological or renal problem (diabetes insipidus)
• Routine blood chemistries
• Arterial blood gas (ABG) and correct acid/base disturbances
• Urinalysis (when indicated)
• Maintain cardiac output and renal perfusion
• Consider the effect of medications on renal tissue (nephrotoxicity)
• Consider urine output in the context of fluid resuscitation
• Toxins can sometimes be removed with urgent/emergent hemodialysis when antidotes fail or are not available

GASTROINTESTINAL SYSTEM

• Monitor nasogastric (NG)/orogastric (OG) tube for patency and residuals
• Perform a thorough abdominal exam
  • Tense abdomen may indicate bowel perforation or hemorrhage
• Consider abdominal ultrasound and/or abdominal CT
• Routine blood chemistries including liver panel
• Arterial blood gas (ABG) and correct acid/base disturbances
• Be vigilant for bleeding into the bowel, especially after hemorrhagic shock

HEMATOLOGICAL SYSTEM

• Monitor complete blood count and coagulation panel
• Transfuse (as needed)
  • Correct thrombocytopenia
  • Fresh frozen plasma is to replenish clotting factors
  • Consider calcium chloride or gluconate if massive transfusion required
• Correct metabolic abnormalities (chemistry panel), especially after transfusion

Many health care providers who are required to obtain regular PALS Certification, also need NRP (Neonatal Resuscitation Program) Certification. NRP is generally required for doctors and nurses working in delivery rooms, nurseries and similar environments where the life support of infants and newborns in critical. If you are looking for a quick & comprehensive solution, we recommend checking out HCPCertifications.com for Online NRP Certification.