For more than a decade, Targeted Temperature Management (TTM) has been the recommended treatment modality in adult comatose patients following out-of-hospital cardiac arrest (OHCA)[1] in order to improve survival and neurological outcome by minimizing brain injuries due to anoxia and reperfusion injury. Initially, cooling was recommended to 32° C-34° C[6, 7], but the enhanced effect of cooling at 33° C compared to 36° C in terms of mortality and neurological outcome could not be proven[2]. Since the most optimal cooling level is yet unknown, current (2015) Resuscitation Guidelines recommend mild hypothermia treatment regimen at the temperature range between 32° C and 36° C[3, 4]. Mild hypothermia is generally considered gentle and safe[8] although a minor subset of patients may experience side effects such as infections, coagulation and electrolyte disturbances and potentially life-threatening arrhythmias during post-cardiac arrest care[5]. …show more content…
The lowest safe cooling threshold in order to avoid the development of malignant ventricular arrhythmias is still not defined. The clinical ECG findings of hypothermia include reversible and temperature-dependent abnormalities: morphology (Osborn waves), rhythm (bradycardia, premature atrial and/or ventricular beats, atrial fibrillation, VT/VF), time (prolonged PR, QRS, and QT intervals ) and conduction (AV-block)[14, 15]. The temperature decrease results in alterations of the autonomic sympathetic response[11] and in impaired conduction velocity of the electrical signals through the
Optimizing the thermal environment has proven significant for improving the chances of survival for small infants. Understanding the basic physiologic principles and current methodology of thermoregulation is important in the clinical care of these tiny infants.
Purpose: The purpose of this speech is to educate and inform my audience of the risks inherent from unintended hypothermia. I’m eager to alert perioperative staff of the potential dangers as well as the preventative measures that can be taken in order to avoid complications associated with unintended hypothermia. My central idea is hypothermia management saves lives.
He then took samples of urine, blood, and mucous as body temperatures lowered. Through this tortured, Rascher used the data to create the hypothermia treatment called "active rapid rewarming." More than 90 people lost their lives for this medical advancement (Adams).
Table 1. This table shows the recording of the amplitude, period, and BPMs for the ventricular contractions before and the effects of the Cold Ringer’s after.
Koran Z. Therapeutic Hypothermia in the Post-Resuscitation Patient: The Development and Implementation of an Evidence-Based Protocol for the Emergency Department. J Trauma Nursing 16: 48-57, Jan-March 2009. Web. 20 June 2015.
These procedures are not reported alone but as add-on codes used to identify extraordinary conditions of patients and their unusual risk factors. There are four kinds of certain codes used for particular circumstances which are: 1) Anesthesia for the age younger than one year and over the age of seventy (99100), 2) Anesthesia complicated by the utilization of total body hypothermia (99116), 3) Anesthesia complicated by the utilization of controlled hypotension (99135) and 4)Anesthesia complicated by emergency circumstances
A Glasgow Coma Score of 8 or less also is an indication that the patient will need to be intubated soon. Once the tube is placed the ventilation may be useful in controlling the intracranial pressure as an intervention. Hyperventilation is a method used to reduce the carbon dioxide concentration in the vessels causing vasoconstriction which lessens the amount of blood circulating in the brain resulting in a decreased ICP (Zink and McQuillan, 2005). According to Zink and McQuillan, this intervention should only be utilized 24 hours after the initial injury because cerebral blood flow is often reduced at this point and constricting the vessels more may cause ischemia to occur. While using this technique it is important to monitor oxygenation to the brain tissue to assure no irreparable damage is
This standard only seemed important once the use of ventilators became popular in hospitals around the world. An argument made in favor of the total brain death is that people who have been determined ‘brain dead’ are great prospects for organ donation (Council, p. 8). As a way to support this argument it is said that because there is artificial respiration and circulation, the blood will continue to circulate throughout the body, which will in turn maintain the durability of the organs needed for surgical removal and therefore enhancing their use for their awaiting recipients (Council p. 8). There are also arguments that do not particularly agree with the total brain death standard and would assumingly prefer the cardiopulmonary standard of death. A downside pointed out by Robert D. Truog in the article “Is it Time to Abandon Brain Death?” is that as a hypothermic patient you are not able to be tested for brain death. According to Truog “the circularity of this reasoning can be clinically problematic, since hypothermic patients cannot be diagnosed as brain-dead but the absence of hypothermia is itself evidence of brain function” (Truog). While continuing to support his argument Truog mentions that “clinicians have observed that patients who fulfill the tests for brain
The evidence surrounding the topic of therapeutic hypothermia post cardiac arrest is one lathered in potentially advantageous benefits, as well as harmful side effects. Although this procedure has potentially lifesaving and neurologically preserving implications, it does come with various side effects which can be dangerous in general or if left untreated. This paper will first address the many benefits, some of which include prolongation of life, retention of neurological function. It will then shed light upon some of the subsequent risks and harmful effects that are associated with therapeutic hypothermia. Lastly the paper will discuss why or why not the overall benefits outweigh the aggravating factors. Thus, being a topic of much controversy
During therapeutic hypothermia, body temperature is lowered to 89.6°F–93.2°F. The procedure is usually done as soon as possible after the heart is restarted and a pulse is felt. Cooling may last between 12-24 hours.
In this article published in the journal Dyanmics, also known as the journal for the Canadian Association of Critical Care Nurses, the authors review a retrospective cohort regarding the barriers for time to target temperature management in cardiac arrest patients who are treated with therapeutic hypothermia. The article authored by a both registerd nurses and medical doctors open by reviewing the benefits of therapeutic hypothermia. The article reviews two randomized controlled trials that showed that therapeutic hypothermia when compared to no intervention correlated with improved neurological survival in patients after cardiac arrest. Therapeutic hypothermia has a direct relation to patient survival with intact neurologic function; however
Hypothermia is not a widely used treatment due to risk for complications associated with hypothermia such as pneumonia, seizures and infection.
The safety and benefits of hypertonic saline resuscitation extend to both the pediatric and geriatric populations, but using solutions at the lower end of tonicity is probably safer. The greatest benefit may ultimately be for those patients with the most limited cardiopulmonary reserves, those with inhalation injury, and those with larger burns approaching 40% or
Shivering is a common problem during spinal anesthesia. It is the hypothermia that actually lowers the threshold for shivering which induces tachycardia, hypertension, and increase oxygen consumption by 400–500%. [1] In spinal anesthesia, there is peripheral redistribution of heat, loss of vasoconstriction below the level of the block with increase of heat loss from body surfaces, and altered thermoregulation with decrease in shivering thresholds. [2]
Freezing is a complicated process. In ideal conditions, a team of cryonicists wait nearby at the time of death, which greatly increases the chances for the patient to be successfully cryopreserved. However, the suspension procedure can only begin once the patient has been declared legally dead by a physician. Afterwards, steps are taken to postpone the body’s breakdown process. This is done by cooling in ice and water, and maintaining the flow of blood in the body. Cardiopulmonary support (CPS), a method similar to cardiopulmonary resuscitation (CPR) keeps the blood circulating. Drugs are administered to reduce the risk of blood clots. Next, CPS is replaced with a heart-lung machine. The heat-exchanger in the heart-lung machine causes the patient’s