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Critical Care Malibag: What is ROSC?

Rob Orman, MD and Scott Weingart, MD
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16:39
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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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01:01

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EM:RAP 2017 May Written Summary 839 KB - PDF

We talk a lot about ROSC, but what is it? Sometimes it’s obvious, but often it’s a grey area and circulation has ‘kind of’ returned.

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Richard S. -

Thanks for addressing my question on "What is ROSC"? Certainly a perfusing pressure as assessed by an a-line would qualify. However, I would speculate that the large majority of your listenership, practicing in non-academic settings, do not place a-lines for codes. If that is indeed the case, then evaluation of ROSC remains elusive in practice. Perhaps that's then the best that can be said.

Rick Spencer, M.D.
Baltimore, MD

P.S. Suggestion--you could incorporate a simple survey-of-the-month button for your subscribers. For example: How often do you place a-lines during a code? and get some actual data on who's doing what for the myriad practice variations discussed on the show.

Michael P. -

Thank you for this discussion of an important topic. I wanted to comment on the way in which Dr. Weingart described the use of ultrasound in placing femoral arterial lines during cardiac arrest, because I am concerned that some listeners may extrapolate the technique used in these circumstances to other less emergent scenarios. The step-wise inching of the transducer followed by the needle as it descends towards the target allows the practitioner to ensure they are visualizing the very tip of the needle instead of the shaft. It should go like this, "see the needle in the image --> move the probe forward --> don't see the needle --> move the needle forward --> see the needle again". We call this the "leap-frog" technique. Without this technique there is risk of the real and very common error of overshooting your target, which usually means puncturing whatever is deep to the target. I agree completely with Dr. Weingart that in a critically ill patient, you do not want to spend excess time fumbling around with the needle and therefore in this scenario you might substitute an "ultrasound-assisted" approach whereby you visualize your target, aim and confirm with aspiration without necessarily visualizing the entire path of the needle. However, the aforementioned "leap-frog" technique is a skill of paramount importance that I do not want early learners to neglect as it is necessary for safety and success in many ultrasound guided procedures.

Michael Prats, MD
Columbus, OH

John V. -

What ever happened to end tidal CO2 as an efficient noninvasive measure of ROSC? A MAP of 50 could mean different things for different patients but an ET CO2 of >40-45 seems far more prognostic of ROSC.

megan c. -

Listening to this in car with husband who is a judge. He says, " echo schmeco" you guys ( meaning us EM docs) worry about stuff too much. All you need is some cap refill in your fingers.
Be glad he did not go to med school.

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Red, Hot, and Shot Full episode audio for MD edition 237:30 min - 331 MB - M4AEMRAP 2017 May Aussie Edition Australian 22:03 min - 30 MB - MP3EM:RAP 2017 May Canadian Edition Canadian 12:11 min - 17 MB - MP3EM:RAP 2017 May Spanish Edition Español 77:25 min - 106 MB - MP3EM:RAP 2017 May French Edition Français 23:24 min - 32 MB - MP3EM:RAP 2017 May German Edition Deutsche 73:18 min - 101 MB - MP3EM:RAP 2017 May Board Review Answers 211 KB - PDFEM:RAP 2017 May Board Review Questions 171 KB - PDFEM:RAP 2017 May MP3 Individual Segments 316 MB - ZIPEM:RAP 2017 May Written Summary 839 KB - PDF

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