Thursday, September 26, 2013

Therapeutic Hypothermia: Part 2/2

Last post I discussed a little bit about situations where therapeutic hypothermia might be indicated.

This post I thought I'd discuss exactly how it's done. The highlighted points came from this article. It focuses on a research protocol for adults but is a nice jumping off point for scene writing if you wanted to do this for one of your characters.

The type of adult who would be eligible:

1. Adult resuscitated from witnessed arrest from cardiac cause. This is important because then the down time is known and the likelihood of preserving good brain function is more likely versus just prolonging a vegetative state.
2. They are comatose and intubated (on a breathing machine.)
3. Initial rhythm of v-fib/v-tach-- which are lethal heart rhythms that require electricity for conversion to a normal perfusing rhythm. 
4. Have a stable blood pressure after resusitation.

Not eligible:

1. Temperature less than 86 degrees Fahrenheit. This is probably because you are really dead.
2. Pregnancy.
3. Terminal Illness.
4. In a coma prior to arrest.
5. Inherited blood clotting disorder.

How do you cool?

1. Insert a core temperature monitor (into the bladder, heart, or esophagus.)
2. Infuse 20-30cc/kg of normal saline cooled to 39.2 degrees Fahrenheit over 30 minutes.
3. Maintain temperature at 89.6- 93.2 degrees Fahrenheit for 24 hours with cooling blankets.
4. Use sedation as needed and paralytics if the patient is shivering-- the point of this would be that shivering causes expenditure of energy and we wouldn't want that to happen.
5. Nursing care includes lubricating eyes, monitoring urine output, watching blood sugars closely.
6. Rewarm the patient 0.3-0.5 degrees at a time.
7. Don't provide nutrition during this phase-- I'm assuming they mean putting food into someone's gut which makes sense as it wouldn't be getting good blood flow and would just sit there undigested causing problems.

What do you think? Would you ever use therapeutic hypothermia in a scene?

You can further read the article for more in-depth information.

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