Heart 5 · 16 min · ground

ROSC — the heart is the lung's neighbor

AHA 2025 · 6 mL/kg PBW · Pplat ≤30 · ΔP ≤14 · SpO₂ 90–98 · PaCO2 35–45

Load card puts the starting breath on the box. Connect starts the clock. End whenever you want.

58-year-old anterior STEMI, 18 minutes down, ROSC after two shocks. Cold, wet, sat 88%, MAP 62 on norepinephrine and a dab of epi.

Handoff

Cardiogenic shock plus pulmonary edema. PEEP helps the LV and hurts the RV. You have to pick a number and watch the MAP.

3 objectives
  1. 1

    PEEP 8–12 — help the LV without killing MAP

    Too little: foam. Too much: no blood back to the left heart.

  2. 2

    SpO2 90–98% once the probe reads (AHA 2025)

    100% until a sat can be measured. Then wean off 100%. Do not slam to 40%.

  3. 3

    Don't over-ventilate a fresh ROSC

    PaCO2 40–45, not 28. The brain just had a bad day too.

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