Wednesday, December 8, 2010




Phase III of CPR is prolonged life support, a long-term resuscitation
G : Gauging (evaluation and critical care triage)
H : Humanizing the outcome by brain resuscitation measures
I : Intensive therapy for general life support.

In every emergency and critical care setting attempts should be made to quantitative the clinical material in terms of types and severity of insults at that time patients enter the emergency system such as hypoxia time prior to arrest, arrest time, CPR time, hypoxia time after arrest and total insult time.

The degree of unresponsiveness (depth of coma) and its change over time can and should be followed, at least as long as the patient is in the ICU after a cerebral insult. This may be accomplished by standard neurologic evaluation using the Glasgow Coma Scale base on eye opening, motor response and verbal response.

After several hours of long-term life support, the degree of recovery at each point in time should be noted of overall and cerebral performance capability. Briefly, the cerebral performance catagories:
1. Conscious and normal, without disability.
2. Conscious with moderate disability.
3. Conscious with severe disability.
4. Coma or vegetative state, without brain damage.
5. Brain death or death.

The test:
Human Mentation 
The patient's outcome in terms of survival and overall performance capability depends on the severity and duration of insult, the speed and quality of emergency resuscitation, and the early start and quality of brain-oriented, post resuscitation intensive therapy.

That is why after several hours of long-term, life support, the degree of recovery at each point in time should be noted of overall and cerebral performance capability, do brain resuscitation and/or protection.

Cerebral protection - preemptive use of therapeutic interventions to improve neurological outcome in patients who will be at risk for cerebral ischemia. The primary objective is prevention of the deleterious effects of ischemia.

Cerebral resuscitation - refers to therapeutic interventions initiated after an ischemic events. The goal is treatment is ischemia and attenuation of neuronal injury.

Intensive Care
General intensive care monitoring are invasive blood pressure monitoring, pulse oxymetri, continous ECG, SO2, Temperature, urine output, serum lactate, arterial blood gases, ureum creatinin, glucose, chest x ray. 

Advance haemodynamic monitoring is achocardiographym cardiac output monitoring

Cerebral monitoring are EEG for early detection and treatment of seizure activity, CT/MRI

There are also need to monitor patient's airway and breathing, circulation, treatment of Hypothermia, treatment of hyperpyrexia, glucose control and seizure control.

1. Lecture on Prolonged Life Support Block 4.2
2. Skills lab manual book of Prolonged Life Support Block 4.2

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