Page 2470 - Saunders Comprehensive Review For NCLEX-RN

f. Continue to cycle through the above
steps until return of spontaneous
circulation (ROSC) or until CPR efforts
are ceased.

4. Postcardiac arrest care

a. If ROSC is achieved, advanced airway
placement should be done if not
previously established, oxygen
saturation should be maintained
greater than 94%, and hyperventilation
should be avoided.
b. If hypotension is present (systolic blood
pressure less than 90 mm Hg),
vasopressors and IV fluid boluses are
needed.
c. IV fluids include 1 to 2 liters of normal
saline or lactated Ringer’s solution.
d. Vasopressors include epinephrine IV
infusion 0.1 to 0.5 mg/kg/minute,
dopamine IV infusion 5 to
10 mcg/kg/minute, or norepinephrine
0.1 to 0.5 mcg/kg/minute.
e. A 12-lead electrocardiogram should be
done.
f. If the client is following commands,
consider targeted temperature
management to preserve neurological
function, and IV fluids cooled to 4° C
should be used.
g. If ST-elevation myocardial infarction
(STEMI) or other form of acute MI are
suspected, coronary reperfusion
should be done, and the client should
be managed on the critical care unit.
h. Post Cardiac Arrest Care Guidelines:
Adapted from the American Heart
Association. (2018). Part 7: Advanced
cardiovascular life support. Retrieved
from
https://eccguidelines.heart.org/index.php/circulation/cpr-
ecc-guidelines-2/part-7-adult-
advanced-cardiovascular-life-support/
I. Cardiac tamponade
1. A pericardial effusion occurs when the space between
the parietal and visceral layers of the pericardium fills
with fluid.
2. Pericardial effusion places the client at risk for cardiac

2470