Kshitij Chatterjee

Pan CT following cardiac arrest has become my routine practice for the past 6 years. Why? 1. Their heart stopped --> we need to figure out why. CT can identify unexpected or difficult to diagnose causes. e.g. PE, pancreatitis, abdominal catastrophe 2. They were just assaulted for X min with CPR . I've seen flail chest, hemothorax + liver/spleen lacerations. They have thoracoabdominal trauma. 3. CT head identifies catastrophic brain injuries (not early gray-white loss or edema which doesn't mean much if done right post ROSC) but rather massive bleeds or sometimes even strokes. I operationalize it as a CT head non-contrast, CT chest with PE protocol, and then CT abdomen with whatever phase they can get after everything else. Of course, I do not delay transfer to cath lab or OR if there is a specific indication (e.g. STEMI vs. bleeding) but will get a CT after the cause has been reversed in those cases.

Here's my approach to airway management during in-hospital cardiac arrest 👇 I divide arrests into a few groups: 1. Primary Hypoxic 2. Shockable (likely ACS) 3. Others/who knows For patients with primary hypoxic arrest (e.g. witnessed massive aspiration), airway management is a priority. This doesn't mean intubation right from the get-go, however, but rather, good two person BVM initially with oral +- nasal airways. In general, I will move towards intubation ASAP in these patients as once the hypoxia is resolved, ROSC often follows. For patients with shockable arrests, I spend the first 10 min focusing on high quality CPR and defibrillation. I try to use two person BVM +- airways and avoid intubation when possible as intubation is associated with delays in CPR (and possible worse outcomes? PMID: 32531405 For other arrests that are less clear in etiology, I will typically set up for intubation somewhere between 5-10 minutes, or, consider an LMA depending on resources. None of these hard and fast, just some general frameworks I have in my mind as I attend codes.

If you aren't already following Ashley, he is the definitive X educator for hemodynamics. His posts make me understand physiology better every single time.