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We are now going to have a very quick look at post-resuscitation care. Once we have a patient that starts to react, starts to move, starts to breathe again, then we have got to look at how we are going to keep that patient stable until further resources arrive. Remember, when the defib brings a heartbeat back, the breathing not necessarily starts again, the breathing is the first thing to disappear and it is also the last thing to come back. So do not necessarily stop using your bag and mask straightaway. The patient should be breathing around about 12 to 20 breaths a minute, normal, regular breathing before we change the method of actually administering oxygen. When the patient does start to breathe normally, we leave the defib pads in place and leave the defib turned on, we put the patient into the recovery position. The recovery position on their side allows their airway to drain, it allows their breathing to be effective and it puts them in a position that is comfortable and manageable to keep the airway open and the tongue forward.

We can then take the bag and mask off and replace it with a non-rebreather or a trauma mask, still running at 15 litres a minute, but the patient is now taking that oxygen in themselves because their breathing is back to a normal rate. We have done that with the bag and mask, so now we want to get that oxygen into their system and that is done with a normal non-rebreather mask on at 15 litres. We now need to make the patient comfortable and keep them gently warm. We do not warm them up with thermal blankets, hot water bottles or heaters anymore. That was a thing of the past. Now, what we are looking at is post-resuscitation cooling rather than heating, so we want to keep the body temperature as low as we can, not hypothermic, but the temperature down because that affects the clotting process and if this patient has had a heart attack due to a clot, we do not want to create any more clots and warm blood will clot easier than cold wood.

There is a lot of work going on these days about post-resuscitation cooling and icing and this type of thing. The latest findings basically say the cooler we keep the patient, the better. We do not have to strip them off, we do not have to cool them down with ice or anything else at this point, you will just have to remember, recovery position, oxygen, keep the airway open, leave the defib running, maintain their airway, maintain their breathing regulation and rhythm and keep the patient just nice and comfortable, not heated. No thermal blankets, no pillow, nothing that is going to warm that patient excessively. Just let them warm up nice and gentle. Always remember dignity again, always remember bystanders, family members and keep them informed of what you have done, and talk to your patient. Remember, hearing is the last thing to go and it is the first thing to come back. Also, breathing is the first thing to go and the last thing to come back.

So they are your priorities. Talk to the patient, talk to the family and keep everybody under control and calm. Your demeanour or the way you present yourself will reflect on the family and how they react and also the patient when they start to come around from a cardiac arrest, they will have oxygen has been deprived from their brain, so they may come back a little bit combatative, a little bit disorientated, but they may well after a few minutes of post-treatment, actually sit up and start talking to you. Post-resuscitation care is important. Take your time, nice and steady, think your way through it. Airway, breathing, circulation, leave the defibrillator on and the lid open. We never close the defibs down because once we do, they turn off. If the patient should go into cardiac arrest again, whilst or post-resuscitation, we start at the beginning again. The defib goes and is used, the chest compressions start again and we go back to the bag and mask.

So remember, if during post-resuscitation care, the patient converts back into a shockable rhythm, we literally go back to the beginning and start again. It is not difficult, do not make it difficult, keep it simple, simple works. But post-resuscitation care is as important as getting the patient back in the first place. How we look after them from this point on makes a difference to their survivability.