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Post Resuscitation Care

Please purchase the course before starting the lesson.

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.

If a patient has a Return of Spontaneous Circulation (ROSC), start Post-Resuscitation Care immediately. The initial PALS process is intended to stabilize a patient 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.

Pediatric Advanced Life Support (PALS) Certification Course

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