Conclusion

A commitment to treat cardiac arrest is a commitment to critical care after resuscitation. The patient who survives should generally be managed in an intensive care unit and is likely to need at least a short period of mechanical ventilation. If the conscious level does not return rapidly to normal, induced hypothermia should be considered.

Predicting longer term neurological outcome in the immediate post-arrest period is fraught with difficulties. The initial clinical signs are not reliable indicators. The duration of the arrest and the duration and degree of post-arrest coma have some predictive value but can be misleading. Although not valid immediately after the arrest, electrophysiological tests, especially SSEPs, are valuable adjuncts to support a clinical judgement of very poor neurological recovery.

Unless an informed, senior opinion has been sought, received, and agreed, the decision to resuscitate must always be followed by full post-resuscitation care.

Blood glucose may rise as a stress response, particularly if there has been a serious cerebral insult, and this may be exacerbated by adrenaline (epinephrine) or underlying diabetes. Blood glucose levels should be kept within the normal range to avoid the harmful effects of both hyperglycaemia (increase in cerebral metabolism) and hypoglycaemia (loss of the brain's major energy source)

A prolonged period of cardiac arrest or a persistently low cardiac output after restoration of a spontaneous circulation may precipitate acute renal failure, especially in the face of pre-existing renal impairment. It may be necessary to consider haemofiltration for urgent correction of intractable acidosis, fluid overload, or severe hyperkalaemia, and to manage established renal failure in the medium term. In renal failure after cardiac arrest, remember to adjust the doses of renally excreted drugs such as digoxin to avoid toxicity

Further reading

• Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Eng J Med 2002;346:557-63.

• Inamasu J, Ichikizaki K. Mild hypothermia in neurological emergency: an update. Ann Emerg Med 2002;40:220-30.

• Jorgensen EO, Holm S. The course of circulatory and cerebral recovery after circulatory arrest: influence of pre-arrest, arrest and post-arrest factors. Resuscitation 1999;42:173-82.

• Morris HR, Howard RS, Brown P. Early myoclonic status and outcome after cardiorespiratory arrest. J Neurol Neurosurg Psychiatry 1998;64:267-8.

• Premachandran S, Redmond AD, Liddle R, Jones JM. Cardiopulmonary arrest in general wards: a retrospective study of referral patterns to an intensive care facility and their influence on outcome. J Accid Emerg Med 1997;14:26-9.

• Robertson CE. Cardiac arrest and cardiopulmonary resuscitation in adults. Cambridge textbook of accident and emergency medicine. Cambridge: Cambridge University Press, 1997, pp. 62-80.

• The Hypothermia After Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Eng J Med 2002;346:549-56.

• Zandbergen EGJ, de Haan RJ, Stoutenbeek CP, Koelman JHTM, Hijdra A. Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet 1998;352:1808-12.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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