翻了ICU book, cardiac arrest的chaper, 發現幾個挺有趣的內容, 順手就把他key了下來...
Since fewer than 10% of cardiac arrest victims survive the experience, CPR can hardly be
called effective, yet it is universally embraced as standard of care --> 存活率真的很低, 病人救得回
來的話, 都算是種神蹟
A threshold of 10 mm Hg for end-tidal PCO2 cane be used to predict outcome: i.e., when end-
tidal PCO2 does not rise above 10 mm Hg during CPR, the resuscitative effort is unlikely to be
successful --> 不過實際在practice的時候, 似乎很少用end-tidal CO2的機器 (雖然說2010年的ACLS大力推薦end-
tidal CO2的重要性)
During CPR, arterial blood gas analysis often reveals a respiratory alkalosis (indicating
operator-induced hyperventilation), while venous blood gas analysis often reveals a metabolic
acidosis (indicating systemic hypoperfusion). Therefore, venous blood gas analysis is more
appropriate for evaluating tissue perfusion during CPR --> 這個結論推翻了我以前對ABG還有VBG的認知
(至少覺得PH, bicarbonate, BE應該不會差太多,原來是有差的!!). 但實際上, ABG在CPR過程中並不會反覆的一直抽
Duration of coma
1. Failure to regain consciousness after CPR has prognostic significance if the coma persists for longer than 4 to 6 hours.
2. Fewer than 15 % of patients will recover fully if their coma persists for longer than 4 to 6 hours after cardiac arrest
3. If a patient is not awake 24 hours after a cardiac arrest, there is only a 10% chance of satisfactory neurologic recovery
4. A Glasgow Coma Score less than 5 points on the third day following cardiac arrest will identify patients with little or no chance of neurologic recovery * Four clinical signs that act as independent predictors of death or poor neurologic recovery after cardiac arrest
看到這個數字, 對我的幫助真的很大. 至少對於以後到ICU的時候, 有一個明確的數字跟家屬說, 病人醒來的機率到底有多少
a. No corneal reflex
b. No papillary light reflex
c. No withdrawal to pain
d. No motor response
The presence of any these signs 24 hours after cardiac arrest carries a poor prognosis for neurologic recoevery
這樣我以後就知道對CPR後ROSC病人該做哪些PE
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