Pitfalls

  • All critically ill patients demand physician presence at the bedside so that rapid reassessment of clinical response to interventions can be made. They cannot be managed ‘from afar’
  • Post-arrest patients have a conflicting need to perfuse the post-ischaemic brain without too much strain on the post-ischaemic heart
  • The need for adequate sedation must be balanced against the risk of worsening cardiovascular instability
  • An unconscious patient is at great risk of unrecognised hypoglycaemia, so cautious glycaemic control is preferred
  • Pyrexia is common post-arrest and must be avoided – it correlates with a worse neurological outcome
  • Absent pupillary reflexes and absent motor response to pain are of no prognostic value soon after ROSC (but are of value at 72 hours)
  • Advanced age does NOT predict poorer neurological outcome in patients with ROSC post-cardiac arrest
  • pH on initial ABG post ROSC does not correlate with cardiac arrest survival
  • The perception of a poor outcome being likely may well affect the resuscitative teams’ efforts and become a ‘self-fulfilling prophecy’
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