EMT Chapter 25-MCIT-F3-2209 | After The Rhythm Returns:  This chapter deals with post_rosk care where resuscitation stops being a protocol and becomes a race against physiology. This chapter gives the EMTs the practical tools to manage the fragile window- maintaining the airway and oxygen targets , supporting circulation, recognizing early deterioration,  coordinating with ALS, and delivering the high quality care that determines whether the patient simply survives or survives with a brain that works. 

The lessons covered are

• Lesson 1:  The Reality of Post-rosk Physiology
• Lesson 2:  The Five Norms: Advanced EMT Approach
• Lesson 3:  Targeted Temperature Management For EMTs
• Lesson 4:  Recognition Of Instability And Transport Decision-Making, and
• Lesson 5:  The Handoff That Saves Brains: S-BAR Excellence

Excerpt from EMT Chapter 25-MCIT-F3-2209 | After The Rhythm Returns

Blood pressure—this is often your biggest challenge with post-rosk patients. The updated guidelines say we need a Mean Arterial Pressure, or MAP, above 65, because MAP is what actually drives blood into the brain. But here’s the reality: getting an accurate MAP in the back of a moving ambulance with a standard blood pressure cuff is tough. So, we use systolic blood pressure greater than 90 as our practical target.  Although if you’re seeing systolic pressures in the 90s, the brain may not be getting perfused adequately. Remember from the last lesson? The heart is stunned and weak, the blood vessels don’t respond normally, and you don’t have the medications to really fix this problem. So, what can you do? Position the patient appropriately, give fluid boluses if your protocols allow, monitor frequently, and maintain that low threshold for calling ALS when the pressure won’t come up.