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Post Resuscitation Care After RoscAPPROACH

RESUSCITATION AND UNIVERSAL APPROACHES · 19 SECTIONS

⚲

359 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Unresponsive Patient Airway Obstruction And Stridor Acute Respiratory Distress With Impending Failure Peri-arrest Hypotension Post Resuscitation Care After Rosc Cardiac Arrest Rhythms, Pea, Asystole Cardiac Arrest Rhythms, Vf, Pulseless Vt Severe Agitation With Safety Risk Procedural Sedation

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx26

Arrest and resuscitation timeline

›Timeline summary

›Witnessed status

›Last known well time

›Collapse time

›CPR start time

›First rhythm

›Defibrillation count

›Epinephrine total dose

›Antiarrhythmic exposure

›Airway and ventilation method

›ROSC time

›Total low flow time

Pre arrest context

›Pre arrest events

›Chest pain

›Dyspnea

›Syncope

›Seizure like activity

›Trauma

›Drowning

›Electrical injury

›Suspected overdose

›Major bleeding

Baseline and goals

›Baseline status

›Baseline functional status

›Known limitations of care

02Alarm Features/alarm20

Immediate rearrest risk and instability

›Time critical threats

›Recurrent VF or pulseless VT

›Recurrent PEA or asystole

›Persistent hypotension

›Refractory hypoxemia

›Severe acidosis

›Hypoglycemia

›Hyperkalemia

›Tension pneumothorax concern

›Tamponade concern

Neurologic danger signs

›High risk neurologic features

›Persistent coma

›Continuous convulsive activity

›Myoclonus with coma

›Fixed pupils with shock

Coronary and shock red flags

›High risk cardiac features

›STEMI pattern

›Cardiogenic shock

›Recurrent ventricular arrhythmia

›Suspected massive pulmonary embolism

03Medications/meds34

Current and recent exposures

›Medication reconciliation priorities

›Anticoagulants

›Antiplatelets

›Beta blockers

›Calcium channel blockers

›Digoxin

›Antiarrhythmics

›QT prolonging agents

›Insulin and hypoglycemics

›Opioids

›Sedatives

›Antipsychotics

ICU compatible agents

›Common post ROSC infusions

›Norepinephrine infusion

›Titrate to MAP target local protocol dependent

›Escalation if rising dose requirement

›Epinephrine infusion

›Consider if bradycardic shock phenotype

›Escalation if lactate rising

›Vasopressin infusion

›Adjunct for catecholamine sparing

›Monitor ischemia

›Propofol infusion

›Avoid if refractory hypotension

›Monitor triglycerides

›Fentanyl infusion

04Diet/diet7

Nutrition strategy

›Intake plan

›NPO status during active stabilization

›Enteral nutrition timing local protocol dependent

›Aspiration risk with depressed reflexes

Glycemic intake considerations

›Glucose strategy

›Avoid dextrose boluses unless hypoglycemia

›Avoid overly tight glucose control

05Review of Systems/ros7

Pre arrest symptoms screen

›Symptom clusters

›Cardiac ischemia symptoms

›Heart failure symptoms

›Pulmonary embolism symptoms

›Infection symptoms

›Toxin exposure symptoms

›Neurologic prodrome symptoms

06Collateral History and Family History/chafh9

Collateral sources

›Source and reliability

›EMS report

›Witness report

›Family report

›Facility report if applicable

Inherited and familial conditions

›Family history focus

›Sudden cardiac death

›Channelopathy history

›Cardiomyopathy history

07Risk Factors/rf21

Cardiac arrest etiology risks

›Cardiac risks

›Coronary artery disease risk factors

›Known heart failure

›Known cardiomyopathy

›Prior ventricular arrhythmia

›Long QT risk

Thrombosis and embolic risks

›Venous thromboembolism risks

›Recent surgery

›Recent immobility

›Active cancer

›Estrogen exposure

Exposure and overdose risks

›Toxin risks

›Opioid exposure

›Stimulant exposure

›Carbon monoxide exposure

›Cyanide exposure risk context

Special populations

›Population modifiers

›Pregnancy status

›Chronic kidney disease

›Chronic liver disease

›Immunocompromised status

08Differential Diagnosis/ddx25

Life threatening

›Cannot miss causes

›Acute coronary occlusion with STEMI

›Massive pulmonary embolism

›Tension pneumothorax

›Cardiac tamponade

›Severe hemorrhage

›Severe hypoxia

›Severe hyperkalemia

›Hypothermia

›Toxin induced arrest

Common

›Likely causes

›Acute coronary syndrome without STEMI

›Primary ventricular arrhythmia

›Respiratory failure

›Sepsis related arrest

›Aspiration and airway failure

Less common

›Less frequent causes

›Aortic dissection

›Intracranial hemorrhage

›Status epilepticus with hypoxia

›Anaphylaxis

Mimics and pitfalls

›Common pitfalls

›Pseudo PEA from severe hypovolemia

›Artifact misread as VF

09Past Medical History/pmh20

Cardiopulmonary history

›Relevant conditions

›Coronary artery disease

›Heart failure

›Valvular disease

›COPD

›Asthma

›Pulmonary hypertension

Neurologic history

›Relevant conditions

›Epilepsy

›Prior stroke

›Dementia

Devices and procedures

›Device history

›Pacemaker

›ICD

›LVAD

›Recent PCI

Baseline care context

›Baseline supports

›Home oxygen

›Dialysis schedule

›Recent hospitalizations

10Physical Exam/exam24

General and perfusion

›Global assessment

›Temperature pattern

›Skin perfusion

›Capillary refill

›Signs of bleeding

Airway and breathing

›Respiratory exam

›Tube position indicators

›Breath sounds symmetry

›Work of breathing if not intubated

Circulation and shock phenotype

›Hemodynamic exam

›Jugular venous distension

›Rales and congestion

›Peripheral edema

›Cardiac murmurs

Neurologic exam

›Neuro status

›GCS

›Pupils

›Corneal reflexes

›Motor response

›Myoclonus

Skin and trauma survey

›Secondary survey

›Trauma signs

›Track marks

11Lab Studies/labs30

Immediate post ROSC panel

›Core labs

›Blood gas

›PaCO2 target normal range local protocol dependent

›Lactate trend for perfusion

›Glucose

›Treat if hypoglycemia

›Avoid severe hyperglycemia

›Electrolytes

›Potassium correction if abnormal

›Magnesium correction if low

›CBC

›Hemoglobin for bleeding

›Leukocytosis context

›Coagulation studies

›INR

›aPTT

›Troponin

›Trend interpretation

›Not specific for occlusion alone

Etiology directed labs

›Cause directed tests

›Toxicology testing

›Acetaminophen level if unknown ingestion

›Salicylate level if unknown ingestion

›Cultures if infection concern

›Blood cultures before antibiotics when feasible

›Urinalysis if urinary source concern

12Imaging/img16

Scoring Systems

›Post arrest neurologic prognostication frameworks

›Multimodal prognostication timing

›Avoid early prognostication before confounders cleared

MRI

›Brain MRI role

›Diffusion weighted imaging for hypoxic ischemic injury timing local protocol dependent

›Contraindications

›Sedation and transport risk

›CT strategy

›CT head for noncardiac cause concern

›CT chest PE protocol if massive PE concern

›CT angiography aorta if dissection concern

Ultrasound

›POCUS priorities

›Cardiac POCUS for function and effusion

›Lung POCUS for pneumothorax and edema

›IVC assessment limitations

›DVT compression ultrasound if PE pathway

13Special Tests/spec15

Cardiac evaluation

›Cardiac tests

›Transthoracic echocardiography

›Global function

›Regional wall motion abnormality

›Pericardial effusion

›Coronary angiography

›STEMI indication urgent

›Non STEMI selection local protocol dependent

Neurologic monitoring

›Neurologic tests

›Continuous EEG

›Nonconvulsive seizures detection

›Sedation confounding

›Somatosensory evoked potentials local protocol dependent

›Timing after rewarming if temperature control used

›Technical limitations

14ECG/ecg11

Post ROSC ECG interpretation

›ECG priorities

›STEMI criteria

›New LBBB pattern concern local protocol dependent

›QTc prolongation

›Brugada pattern

›WPW pattern

›Ventricular ectopy burden

Serial ECG logic

›Repeat ECG triggers

›Recurrent chest pain

›Rising troponin with instability

›Dynamic ST T changes

15Assessment/ax14

Working problem list

›Post cardiac arrest syndrome

›Brain injury risk

›Myocardial dysfunction

›Systemic ischemia reperfusion response

›Etiology likelihood

›Cardiac primary likelihood

›Respiratory primary likelihood

›Toxin primary likelihood

›Neurologic primary likelihood

Severity and risk stratification

›High risk features

›Shock requiring escalating vasopressors

›Persistent coma

›Refractory hypoxemia

›Refractory arrhythmia

16Plan/plan38

Differential Management

›!Acute coronary syndrome (STEMI)→

First 15 minutes stabilization

›Immediate priorities

›Airway confirmation

›End tidal CO2 confirmation

›Chest rise and bilateral breath sounds

›Oxygenation target local protocol dependent

›Avoid hyperoxia

›Avoid hypoxemia

›Ventilation target local protocol dependent

›Avoid hypocapnia

›Avoid hypercapnia

›Hemodynamic target local protocol dependent

›MAP at least 65 mmHg typical starting target

›Individualize for chronic hypertension

Temperature control

›Temperature management local protocol dependent

›Active fever prevention

›Targeted temperature management selection in comatose patients

›Shivering control strategy

Etiology directed therapy

›Cause specific actions

›STEMI pathway activation

›Suspected massive PE

›Thrombolysis consideration local protocol dependent

›Catheter directed therapy consideration local protocol dependent

›Suspected overdose

17Disposition/dispo16

Level of care

›Disposition criteria

›ICU admission default after ROSC

›Cath lab activation if STEMI

›Transfer to tertiary center local protocol dependent

Objective admission triggers

›ICU triggers

›Any vasopressor requirement

›Mechanical ventilation

›Persistent coma

›Targeted temperature management use

›Recurrent arrhythmia

Rare discharge pathway

›Discharge only if all met local protocol dependent

›Brief arrest from reversible cause fully treated

›Normal mental status

›Stable vitals without support

›No high risk ECG features

›Reliable follow up and supervision

18Discharge Instructions/di19

Copy discharge instructions

›Plain language summary

›Cardiac arrest occurred and circulation returned

›Cause treated or suspected

›Medications

›Take medications exactly as prescribed

›Avoid new sedatives unless prescribed

›Activity

›No driving until cleared by clinician

›Avoid heavy exertion until follow up

›Follow up

›Cardiology follow up within 72 hours local protocol dependent

›Family physician follow up within 7 days

›Return to emergency care immediately if

›Chest pain

›Shortness of breath

›Fainting or near fainting

›Palpitations with dizziness

›New weakness

›Seizure activity

19References/r7

Guidelines and landmark evidence

›Core references

›American Heart Association ACLS guidelines 2020 update and subsequent statements local protocol dependent

›ILCOR post resuscitation care consensus statements 2021 to 2024 local protocol dependent

›European Resuscitation Council guidelines 2021 post resuscitation care

›TTM2 trial 2021 targeted hypothermia versus normothermia with fever prevention

›COACT trial 2019 immediate versus delayed angiography after OHCA without STEMI

›Project instructions

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Post Resuscitation Care After RoscAPPROACH

RESUSCITATION AND UNIVERSAL APPROACHES · 19 SECTIONS

⚲

359 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx26

Arrest and resuscitation timeline

›Timeline summary

›Witnessed status

›Last known well time

›Collapse time

›CPR start time

›First rhythm

›Defibrillation count

›Epinephrine total dose

›Antiarrhythmic exposure

›Airway and ventilation method

›ROSC time

›Total low flow time

Pre arrest context

›Pre arrest events

›Chest pain

›Dyspnea

›Syncope

›Seizure like activity

›Trauma

›Drowning

›Electrical injury

›Suspected overdose

›Major bleeding

Baseline and goals

›Baseline status

›Baseline functional status

›Known limitations of care

02Alarm Features/alarm20

Immediate rearrest risk and instability

›Time critical threats

›Recurrent VF or pulseless VT

›Recurrent PEA or asystole

›Persistent hypotension

›Refractory hypoxemia

›Severe acidosis

›Hypoglycemia

›Hyperkalemia

›Tension pneumothorax concern

›Tamponade concern

Neurologic danger signs

›High risk neurologic features

›Persistent coma

›Continuous convulsive activity

›Myoclonus with coma

›Fixed pupils with shock

Coronary and shock red flags

›High risk cardiac features

›STEMI pattern

›Cardiogenic shock

›Recurrent ventricular arrhythmia

›Suspected massive pulmonary embolism

03Medications/meds34

Current and recent exposures

›Medication reconciliation priorities

›Anticoagulants

›Antiplatelets

›Beta blockers

›Calcium channel blockers

›Digoxin

›Antiarrhythmics

›QT prolonging agents

›Insulin and hypoglycemics

›Opioids

›Sedatives

›Antipsychotics

ICU compatible agents

›Common post ROSC infusions

›Norepinephrine infusion

›Titrate to MAP target local protocol dependent

›Escalation if rising dose requirement

›Epinephrine infusion

›Consider if bradycardic shock phenotype

›Escalation if lactate rising

›Vasopressin infusion

›Adjunct for catecholamine sparing

›Monitor ischemia

›Propofol infusion

›Avoid if refractory hypotension

›Monitor triglycerides

›Fentanyl infusion

04Diet/diet7

Nutrition strategy

›Intake plan

›NPO status during active stabilization

›Enteral nutrition timing local protocol dependent

›Aspiration risk with depressed reflexes

Glycemic intake considerations

›Glucose strategy

›Avoid dextrose boluses unless hypoglycemia

›Avoid overly tight glucose control

05Review of Systems/ros7

Pre arrest symptoms screen

›Symptom clusters

›Cardiac ischemia symptoms

›Heart failure symptoms

›Pulmonary embolism symptoms

›Infection symptoms

›Toxin exposure symptoms

›Neurologic prodrome symptoms

06Collateral History and Family History/chafh9

Collateral sources

›Source and reliability

›EMS report

›Witness report

›Family report

›Facility report if applicable

Inherited and familial conditions

›Family history focus

›Sudden cardiac death

›Channelopathy history

›Cardiomyopathy history

07Risk Factors/rf21

Cardiac arrest etiology risks

›Cardiac risks

›Coronary artery disease risk factors

›Known heart failure

›Known cardiomyopathy

›Prior ventricular arrhythmia

›Long QT risk

Thrombosis and embolic risks

›Venous thromboembolism risks

›Recent surgery

›Recent immobility

›Active cancer

›Estrogen exposure

Exposure and overdose risks

›Toxin risks

›Opioid exposure

›Stimulant exposure

›Carbon monoxide exposure

›Cyanide exposure risk context

Special populations

›Population modifiers

›Pregnancy status

›Chronic kidney disease

›Chronic liver disease

›Immunocompromised status

08Differential Diagnosis/ddx25

Life threatening

›Cannot miss causes

›Acute coronary occlusion with STEMI

›Massive pulmonary embolism

›Tension pneumothorax

›Cardiac tamponade

›Severe hemorrhage

›Severe hypoxia

›Severe hyperkalemia

›Hypothermia

›Toxin induced arrest

Common

›Likely causes

›Acute coronary syndrome without STEMI

›Primary ventricular arrhythmia

›Respiratory failure

›Sepsis related arrest

›Aspiration and airway failure

Less common

›Less frequent causes

›Aortic dissection

›Intracranial hemorrhage

›Status epilepticus with hypoxia

›Anaphylaxis

Mimics and pitfalls

›Common pitfalls

›Pseudo PEA from severe hypovolemia

›Artifact misread as VF

09Past Medical History/pmh20

Cardiopulmonary history

›Relevant conditions

›Coronary artery disease

›Heart failure

›Valvular disease

›COPD

›Asthma

›Pulmonary hypertension

Neurologic history

›Relevant conditions

›Epilepsy

›Prior stroke

›Dementia

Devices and procedures

›Device history

›Pacemaker

›ICD

›LVAD

›Recent PCI

Baseline care context

›Baseline supports

›Home oxygen

›Dialysis schedule

›Recent hospitalizations

10Physical Exam/exam24

General and perfusion

›Global assessment

›Temperature pattern

›Skin perfusion

›Capillary refill

›Signs of bleeding

Airway and breathing

›Respiratory exam

›Tube position indicators

›Breath sounds symmetry

›Work of breathing if not intubated

Circulation and shock phenotype

›Hemodynamic exam

›Jugular venous distension

›Rales and congestion

›Peripheral edema

›Cardiac murmurs

Neurologic exam

›Neuro status

›GCS

›Pupils

›Corneal reflexes

›Motor response

›Myoclonus

Skin and trauma survey

›Secondary survey

›Trauma signs

›Track marks

11Lab Studies/labs30

Immediate post ROSC panel

›Core labs

›Blood gas

›PaCO2 target normal range local protocol dependent

›Lactate trend for perfusion

›Glucose

›Treat if hypoglycemia

›Avoid severe hyperglycemia

›Electrolytes

›Potassium correction if abnormal

›Magnesium correction if low

›CBC

›Hemoglobin for bleeding

›Leukocytosis context

›Coagulation studies

›INR

›aPTT

›Troponin

›Trend interpretation

›Not specific for occlusion alone

Etiology directed labs

›Cause directed tests

›Toxicology testing

›Acetaminophen level if unknown ingestion

›Salicylate level if unknown ingestion

›Cultures if infection concern

›Blood cultures before antibiotics when feasible

›Urinalysis if urinary source concern

12Imaging/img16

Scoring Systems

›Post arrest neurologic prognostication frameworks

›Multimodal prognostication timing

›Avoid early prognostication before confounders cleared

MRI

›Brain MRI role

›Diffusion weighted imaging for hypoxic ischemic injury timing local protocol dependent

›Contraindications

›Sedation and transport risk

›CT strategy

›CT head for noncardiac cause concern

›CT chest PE protocol if massive PE concern

›CT angiography aorta if dissection concern

Ultrasound

›POCUS priorities

›Cardiac POCUS for function and effusion

›Lung POCUS for pneumothorax and edema

›IVC assessment limitations

›DVT compression ultrasound if PE pathway

13Special Tests/spec15

Cardiac evaluation

›Cardiac tests

›Transthoracic echocardiography

›Global function

›Regional wall motion abnormality

›Pericardial effusion

›Coronary angiography

›STEMI indication urgent

›Non STEMI selection local protocol dependent

Neurologic monitoring

›Neurologic tests

›Continuous EEG

›Nonconvulsive seizures detection

›Sedation confounding

›Somatosensory evoked potentials local protocol dependent

›Timing after rewarming if temperature control used

›Technical limitations

14ECG/ecg11

Post ROSC ECG interpretation

›ECG priorities

›STEMI criteria

›New LBBB pattern concern local protocol dependent

›QTc prolongation

›Brugada pattern

›WPW pattern

›Ventricular ectopy burden

Serial ECG logic

›Repeat ECG triggers

›Recurrent chest pain

›Rising troponin with instability

›Dynamic ST T changes

15Assessment/ax14

Working problem list

›Post cardiac arrest syndrome

›Brain injury risk

›Myocardial dysfunction

›Systemic ischemia reperfusion response

›Etiology likelihood

›Cardiac primary likelihood

›Respiratory primary likelihood

›Toxin primary likelihood

›Neurologic primary likelihood

Severity and risk stratification

›High risk features

›Shock requiring escalating vasopressors

›Persistent coma

›Refractory hypoxemia

›Refractory arrhythmia

16Plan/plan38

Differential Management

›!Acute coronary syndrome (STEMI)→

First 15 minutes stabilization

›Immediate priorities

›Airway confirmation

›End tidal CO2 confirmation

›Chest rise and bilateral breath sounds

›Oxygenation target local protocol dependent

›Avoid hyperoxia

›Avoid hypoxemia

›Ventilation target local protocol dependent

›Avoid hypocapnia

›Avoid hypercapnia

›Hemodynamic target local protocol dependent

›MAP at least 65 mmHg typical starting target

›Individualize for chronic hypertension

Temperature control

›Temperature management local protocol dependent

›Active fever prevention

›Targeted temperature management selection in comatose patients

›Shivering control strategy

Etiology directed therapy

›Cause specific actions

›STEMI pathway activation

›Suspected massive PE

›Thrombolysis consideration local protocol dependent

›Catheter directed therapy consideration local protocol dependent

›Suspected overdose

17Disposition/dispo16

Level of care

›Disposition criteria

›ICU admission default after ROSC

›Cath lab activation if STEMI

›Transfer to tertiary center local protocol dependent

Objective admission triggers

›ICU triggers

›Any vasopressor requirement

›Mechanical ventilation

›Persistent coma

›Targeted temperature management use

›Recurrent arrhythmia

Rare discharge pathway

›Discharge only if all met local protocol dependent

›Brief arrest from reversible cause fully treated

›Normal mental status

›Stable vitals without support

›No high risk ECG features

›Reliable follow up and supervision

18Discharge Instructions/di19

Copy discharge instructions

›Plain language summary

›Cardiac arrest occurred and circulation returned

›Cause treated or suspected

›Medications

›Take medications exactly as prescribed

›Avoid new sedatives unless prescribed

›Activity

›No driving until cleared by clinician

›Avoid heavy exertion until follow up

›Follow up

›Cardiology follow up within 72 hours local protocol dependent

›Family physician follow up within 7 days

›Return to emergency care immediately if

›Chest pain

›Shortness of breath

›Fainting or near fainting

›Palpitations with dizziness

›New weakness

›Seizure activity

19References/r7

Guidelines and landmark evidence

›Core references

›American Heart Association ACLS guidelines 2020 update and subsequent statements local protocol dependent

›ILCOR post resuscitation care consensus statements 2021 to 2024 local protocol dependent

›European Resuscitation Council guidelines 2021 post resuscitation care

›TTM2 trial 2021 targeted hypothermia versus normothermia with fever prevention

›COACT trial 2019 immediate versus delayed angiography after OHCA without STEMI

›Project instructions

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.