c) List the important differences in managing a cardiac arrest in a post-operative cardiac surgical
patient in ICU as compared to a non-cardiac surgical patient. (40% marks)
• Immediate VF or pacing (if indicated) before external cardiac massage – can delay ECM up to one minute to administer shock/pace
• No need for pulse check – observe monitored waveforms/ECG sufficient for diagnosis • Avoid adrenaline/vasopressin bolus
• Cease all infusions until reviewed
• If IABP in situ set to pressure trigger
• If PEA and paced, turn off pacemaker to exclude underlying VF
• Plan for emergency re-sternotomy, ideally within five minutes.
In short, the basic differences are:
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