ROSC

Assessment

Pediatric Pearls:	Signs & Symptoms:	Differential:
□ Stabilize on scene post-ROSC for 10 minutes to optimize the patient	□ Increased in ETCO2 □ Return of pulses	□ Continue to address specific differentials associated with original dysrhythmia.

Clinical Management Options

EMT-B

• Continue Oxygenation, target SpO2 92% – 96%  • Use Post Resuscitation Checklist as indicated  • Wait 10 minutes prior to transport to help optimize the patient prior to transport

Paramedic

• Vascular access  • Obtain and monitor EKG at 8 minutes • Monitor ETCO2, especially during movement • Fentanyl as needed for comfort • Push-dose epinephrine as needed for hypotension

Pearls

• Reassess airway frequently and with every patient move. 
• Take the time to optimize the patient prior to transport: secure all lines, consider IV access, obtain an EKG, prepare push-dose epinephrine, optimize ETCO2. Patients often re-arrest when transporting to the ambulance. Optimizing the patient prior to transport can reduce this risk.
• It is ideal to wait 8 minutes after ROSC for the EKG. The EKG obtained immediately after the cardiac arrest is abnormal and can hide a STEMI. As many cardiac arrests are from STEMI, it is ideal to get a good EKG to assess for a STEMI. 
• Do not hyperventilate as this is associated with worse outcomes.