Anticipate LOSC (Loss of Spontaneous Circulation). Once you have pulses back with ROSC (Return of Spontaneous circulation) anticipate you will lose them and have your plan in place. Premix your epi or norepi-drip and have it ready to go. Don’t start moving the patient immediately after getting ROSC. I usually wait 5 minutes to get the patient secure and make certain they are stable before starting to carry them down that windy staircase. If they arrest on the staircase, it will difficult both to recognize the lost of pulses and then to start compressions. While most know that a sudden rise in ETCO2 during an arrest signals return of pulses as the restored circulation sweeps the buildup CO2 in the distal portions of a body up to the lungs where it is ventilated off, the reverse applies when a patient loses pulses. ETCO2 45, you have pulses and a blood pressure back, you are all slapping each other on the back on a great job done getting the patient back, when you glance at the ETCO2. It is down to 14. Better get back on the chest. ETCO2 signals the loss of pulses as well as regaining pulses. Check out this trend summary of a patient who arrested three times.
