11: Post-Resuscitation Care (2024)

Chapter 11 discusses Post-Resuscitation Care. The difference between the initial PALS process and post-resuscitation care is explained here. The PALS manual also offers a corresponding Figure (Fig. 17). This in-depth lesson provides a checklist for use when caring for each different system, after resuscitation. Those systems are respiratory, cardiovascular, neurological, renal, gastrointestinal, and hematological.
"If an individual has a return of spontaneous circulation or 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 and tissue function, and maintain recommended blood glucose levels.
For the Pediatric Post-Resuscitation Care Algorithm to guide you in your treatment, refer to Figure 17 in your corresponding PALS manual.
When caring for the respiratory system after resuscitation, follow this checklist:
• Chest x-ray to verify ET tube placement
• Arterial blood gas, or ABG, and correct acid or base disturbance
• Continuously monitor pulse oximetry
• Continuously monitor heart rate and rhythm
• If the individual is intubated, end-tidal carbon dioxide
• Maintain adequate oxygenation (that is, saturation between 94 and 99 percent)
• 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
- You need to maintain a patent airway in the child with a decreased level of consciousness
- Ventilation is not possible through non-invasive means, for example., continuous positive airway pressure, or CPAP
• Control pain with analgesics and anxiety with sedatives (for example, benzodiazepines)
When caring for the cardiovascular system after resuscitation, follow this checklist:
•Arterial blood gas, or ABG, and correct acid/base disturbances
•Transfuse or support hemoglobin and hematocrit as needed
•Continuously monitor heart rate and rhythm
•Continuously monitor blood pressure with arterial line
•Check central venous pressure, or CVP
•Check urine output
•Chest x-ray
•12 lead ECG
•Consider echocardiography
•Maintain appropriate intravascular volume
•Use vasopressors and titrate blood pressure to treat hypotension if needed
•Continuously monitor pulse oximetry
•Maintain adequate oxygenation (that is, saturation between 94 and 99 percent)
•Correct metabolic abnormalities (chemistry panel)
When caring for the neurological system after resuscitation, follow this checklist:
•Elevate head of bed if blood pressure can sustain cerebral perfusion
•Maintain temperature by avoiding hyperthermia and treating fever aggressively; do not re-warm hypothermic cardiac arrest individuals unless hypothermia is interfering with cardiovascular function, and treat hypothermia complications as they arise
•Maintain blood glucose by treating hypo- and hyperglycemia (hypoglycemia is defined as less than or equal to 60 mg/dL)
•Monitor and treat seizures with seizure medications and by removing metabolic and toxic causes
•Continuously monitor blood pressure with arterial line
•Maintain cardiac output and cerebral perfusion
•Normoventilate unless temporizing due to intracranial swelling
•Perform frequent neurological exams
•Consider CT and/or EEG (electroencephalogram)
•Keep in mind that dilated unresponsive pupils, hypertension, bradycardia, respiratory irregularities, or apnea may indicate cerebral herniation"
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