Tuesday, February 24, 2015

Care After Return of Spontaneous Circulation: TABLE

Care after ROSC - Think TABLE Acronym
After performing emergency basic life support and perhaps advanced life support, the person has regained spontaneous circulation. Although a good sign, the goal of emergency care shifts to supporting the person's status with the hopes of regaining function that he or she had before the arrest interval.

I tend to remember information better through the use of acronyms, so I created the acronym TABLE to help me to remember how to care for someone who has regained spontaneous circulation after emergency care. This is not a step-by-step linear guide. In reality, many of these actions are performed simultaneously by various members of the team.

After ROSC...think TABLE!

T
Transport to appropriate level of care
  • In hospital - transfer to ICU
  • Out of hospital - transfer to appropriate hospital via land, air, water as appropriate
Assist survivors emotionally and provide information they need to make wise decisions regarding care.
A
Advanced Airway
  • Titrate to keep O2 Sats >94% 
  • Avoid overbagging & secure tube properly
  • Capnography: 10-12 BPM; PetCO2 35-40 or PaCO2 40-45
  • Elevate HOB 30°
B
BP
  • If you have a pulse, you have a BP - monitor all VS
  • SBP at least 90; MAP at least 65
  • Fluid Bolus (NS, LR)
  • Consider cooled fluids with hypothermia protocol if questionable neurological status - no meaningful response to commands
  • Meds: DA 5-10 mcg/kg/min, Norepinephrine/Epi 0.1-0.5 mcg/kg/min
L
Labs
  • Look at Hs/Ts
  • Glycemic control
  • Consider history and interview family or other witnesses to determine reversible causes and possible treatment
E
ECG - 12 lead
  • Assess & treat STEMI (ST elevation, NEW BBB)
  • Consider PCI
  • Watch for arrhythmias and treat appropriately

I have had the great privilege of knowing several people who had CPR performed on them who survived and enjoyed several healthy years after the incident. These are the exception rather than the rule. If you happen to be assisting with resuscitation efforts, I hope you have the opportunity to play a role in helping someone to have that second chance!

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