Introduction
Hypothermia protocol for the post cardiac arrest patient has been an evidence based practice of this therapy for about a decade now. This intervention, often used in the critical care setting, is now expanding to primary emergency responders as well. This paper will present some of the notable research that has been done on therapeutic hypothermia, and current use of this intervention.
Control studies, animal studies, and case studies have been published related to these medical interventions. Unfortunately, there are still many healthcare providers not using this intervention. Dainty, Scales, Brooks, Needham, Dorian, Ferguson et al. (2011) study states, “observational research shows that therapeutic hypothermia is delivered inconsistently, incompletely, and often with delay.” In addition a survey that same study found, of Canada and U.S. physicians who replied, only 26% used hypothermia in resuscitated patients (p. 2).
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Hypothermia protocol is not universally used at all hospitals, but the facilities that do use it have similar methods. Based on two studies done in 2002 the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR) suggested that “unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32°C to 34°C for 12 to 24 hours when the initial rhythm was ventricular fibrillation (VF)” (Writing Group, Nolan, Morley, Vanden, Hickey, Members of the Advanced Life Support Task Force et al., 2003, p. 118). They also stated it could be beneficial for other rhythms as well. This was the first big step in using hypothermia in the critical care setting. The current protocol still uses that recommendation.
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...rch in Cardiology, 106(5), 697-708.
Hammer, L., Vitrat, F., Savary, D., Debaty, G., Santre, C., Durand, M., et al. (2009). Immediate prehospital hypothermia protocol in comatose survivors of out-of-hospital cardiac arrest. American Journal of Emergency Medicine, 27(5), 570-573.
Torgersen, J., Strand, K., Bjelland, T. W., Klepstad, P., Kvale, R., Soreide, E., et al. (2010). Cognitive dysfunction and health-related quality of life after a cardiac arrest and therapeutic hypothermia. Acta Anaesthesiologica Scandinavica, 54(6), 721-728.
Wall, R., J. (2011). Use of therapeutic hypothermia after cardiac arrest. Critical Care Alert, 19(3), 17-20.
Writing Group, Nolan, J. P., Morley, P. T., Vanden Hoek, T. L., Hickey, R. W., Members of the Advanced Life Support Task Force, et al. (2003). Therapeutic hypothermia after cardiac arrest. Circulation, 108(1), 118-121.
Targeted Temperature Management at 33 degree versus 36 degree after Cardiac Arrest (Neilsen et al)
This can be seen in the case study as ethical and legal arise in resuscitation settings, as every situation will have its differences it is essential that the paramedic has knowledge in the areas of health ethics and laws relating to providing health care. The laws can be interpreted differently and direction by state guidelines may be required. Paramedics face ethical decisions that they will be required to interpret themselves and act in a way that they believe is right. Obstacles arise such as families’ wishes for the patients’ outcome, communicating with the key stakeholders is imperative in making informed and good health practice decision. It could be argued that the paramedics in the case study acted in the best interest of the patient as there was no formal directive and they did not have enough information regarding the patients’ wishes in relation to the current situation. More consultation with the key stakeholders may have provided a better approach in reducing the stress and understanding of why the resuscitation was happening. Overall, ethically it could be argued that commencing resuscitation and terminating once appropriate information was available is the right thing to do for the
Rehder, K. J., Turner, D. A., & Cheifetz, I. M. (2011). Use of Extracorporeal Life Support in Adults with Severe Acute Respiratory Failure. Expert Rev. Respir. Med., 5(5), 627-633. http://dx.doi.org/10.1586/ERS.11.57
A do not resuscitate order for patients who have emergency surgery is an “independent risk factor for poor surgical outcome and postoperative mortality” (Kelley , 2014 pg 1 para 3) and the probability of returning patients to their previous level of functioning is higher for CPR performed during the peri-operative period (Kelley , 2014).
Hypothermia is a common problem in surgical patients. Up to 70% of patients experience some degree of hypothermia that is undergoing anesthetic surgery. Complications include but are not limited to wound infections, myocardial ischemia, and greater oxygen demands. The formal definition of hypothermia is when the patient’s core body temperature drops below 36 degrees Celsius or 98.6 degrees Fahrenheit. Thus, the purpose of the paper is to synthesize what studies reveal about the current state of knowledge on the effects of pre-operative warming of patient’s postoperative temperatures. I will discuss consistencies and contradictions in the literature, and offer possible explanations for the inconsistencies. Finally I will provide preliminary conclusions on whether the research provides strong evidence to support a change in practice, or whether further research is needed to adequately address your inquiry.
Early heart attack deaths can be avoided if a bystander starts CPR (cardiopulmonary resuscitation) within five minutes of the onset of ventricular fibrillation.
Khan, M. Faisal M.D. No Date. New Hypothermia Technique Protects Heart Attack Patients. Memorial Hermann. Retrieved from www.fbindependent.com/new-hypothermia-technique-protects-heart-attack-patients-p3615-91.htm. April 18, 2011.
The term “failure to rescue” refers to a clinical scenario where hospital doctors, nurses, or caregivers fail to recognize symptoms. Responders do not respond adequately to clinical signs that would prevent harm (Morse, 2008, p.2). Dr. Jeffery H. Silber, Director of the Center for Health Outcomes and Policy Research, first coined the term “failure to rescue” in the 1990’s. He characterized the matrix of institutional and individual errors that contribute to patient deaths as “failure to rescue” (Aleccia, 2008). Since 1990, it has been well documented patients usually exhibit signs and symptoms of impending cardiac or respiratory arrest 6-8 hours before an arrest (Schein, Hazday, Pena, Ruben, & Spring, 1990). Buist, Bernard, Nguyen, Moore, and Anderson’s (2004) research reported similar findings. They found patients had documented clinically abnormal signs and symptom prior to arrest (Buist, et al., 2004). When certain abnormal signs and symptoms are identified early, critical bedside consultat...
...warming protect any affected body part from direct pressure and ensure the patient is well-hydrated. Do not rub frostbitten skin, attempt to rewarm using a fire or stove, rewarm if there is any possibility of refreezing, and allow the tissue to refreeze if it is successfully thawed (Simon, Bryan).
Augustine Medical, Inc. was founded by Dr. Scott Augustine, an anesthesiologist from Minnesota, in 1987. The company was created to develop and market products for hospital operating rooms and postoperative recovery rooms. The company provides innovative solutions to combat postoperative conditions such as hypothermia. Medical research indicates that 60 to 80 percent of all postoperative recovery room patients are clinically hypothermic. Hypothermia is caused by a patient’s exposure to cold operating room temperatures that are required by surgeons to control infection, and for the personal comfort of the surgeon. Hypothermia can also be a result of heat loss due to evaporation of the fluids used to scrub patients, evaporation from exposed bowel, and breathing of dry anesthetic gases. Dr. Augustine’s personal experience in the operating room convinced him that there was a need for a new system to warming patients after surgery. Dr. Augustine also realized that the market for this new product would be enormous! Statistics indicate that approximately 21 million surgical operations are performed annually in the United States, and that approximately 5,500 hospitals have operating rooms and postoperative recovery rooms that include 31,365 postoperative recovery beds and 28,514 operating rooms. Upon the realization of this need and existence of the market, Dr. Augustine went on to develop The Bair Hugger Patient Warming System then he acquired a patent. The Bair Hugger Patient Warming System consists of a heat source and a separate disposable warming cover that directs a gentle flow of warm air across the body. The Bair Hugger heat source uses a reliable high efficiency blower, a sealed 400W heating element, and a microprocessor based temperature control to create a continuous flow of warm air. The heat source complies with all safety requirements for hospital equipment. Augustine Medical, Inc. was able to find investors that contributed to the initial capitalization of $500,000. These initial funds that were collected were used for staff support, facilities, and marketing. The funds were also used to cover the fixed costs of the company while in its first year. The company subcontracted the production of the heater/blower unit and manufactured the warming covers in-house. The company only par...
CPR is (cardiopulmonary resuscitation). This procedure is used to restore blood circulation and breathing in a person who is in cardiac arrest. All the cells in a human body require oxygen to survive, they also require a good supply of nutrients and removal of all waste products. In your lungs oxygen enters your blood and carbon dioxide is removed, this process is called gas exchange. Cardiac arrest is when your heart completely stops beating. Although your heart stops, this is not the same as a heart attack . a heart attack may lead to cardiac arrest. There are many causes that can put you in a state of cardiac arrest like, drugs, poising and over – dosing on medications, traumatic injury such as a motor vehicle accidents of any kind or any significant amount of blood loss and also anaphylaxis (and allergic reaction to anything) can also lead to cardiac arrest. If any of these happen blood will stop circulating throughout the body. Breathing begins to decrease most of the time you stop breathing for several minutes. The purpose of CPR is to keep oxygen in the blood so it can continue to flow, throughout the body to keep the vital organs alive. CPR will not restart someone’s heart, it just keeps the blood flow circulating until official help arrives , once you come across someone that isn’t breathing you should first see if the scene is clear before you go to help the person( always remember DR ABC always make sure you are not in any DANGER check for a RESPONSE from the person you’re doing CPR on shake them gently . make sure the AIRWAY is clear by kneeling by the persons head and tilting there head backwards . check if the person is BREATHING by placing your ear above their mouth and looking at their chest for normal breathin...
Wang H, Yealy D. Out-of-hospital endotracheal intubation: where are we? Annals of Emergency Medicine [serial online]. June 2006; 47(6):532-541. Available from: CINAHL Plus, Ipswich, MA. Accessed March 7, 2014.
With the establishment of the DNR order, withholding CPR from an individual has reformed into standing as “ethically appropriate if the anticipated benefit outweighs the harm. However, since then, the literal meaning of DNR has not been clear, thus causing confusion that remains problematic in clinical practice” (Yen-Yuan 4). With the renovation of the DNR order, people and health care providers have worked to progress defining what the DNR order stands for along with people gaining autonomy in their choice of death. Additionally, associations and activists keep pushing forward in the refinement of the DNR order: “there has been increasing focus on promoting quality of care for the dying [. . .] However, the persistent problems with DNR orders suggest that physician behaviors toward communication with patients about goals of care and resuscitation decisions have not measurably changed in the past 20 years” (Yuen 7). Through the efforts of benefactors such as the American Heart Association and others, the DNR order will continue to increase in quality over time as improvements are made. The DNR order sprouted from the first incentives that people deserve a say in how they shall die and today has transformed into a necessity that functions to entitle people to their own choice of death or
Clinical question: What is the most effective and most practical way for cooling the patient?
CPR is a very effective method when dealing with a victim suffering from cardiac arrest. CPR involves chest compressions of at least 2in (5cm) deep and at a rate of at least 100 compressions per min, this helps to pump blood through the heart and also the body. The main goal of CPR is to try and stop tissue death. It’s also use to prolong for a successful resuscitation without causing permanent brain damage. CPR can be performed on adults, children, even animals. CPR can be used by one or more than one person.