Therapeutic Hypothermia ChillOut

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Transcript of Therapeutic Hypothermia ChillOut

Therapeutic Hypothermia Post Cardiac ArrestPrepared and Presented by: Cameron Schmidt MS RN Clinical Teacher Critical Care Education

Introduction Clinically induced hypothermia is an evidence based intervention strategy that can improve the neurologic outcome of unconscious patients post sudden cardiac arrest

Introduction Brain temperature during the first 24 hours after resuscitation from Cardiac Arrest may have significant effect on survival and neurologic recovery

Goals The goal is to obtain a core temperature of 32-34 degrees C. Our Goal:33 degrees C (91.4 F) within 6 hours of the onset of cardiac arrest and to maintain core temperature of 32-34 degrees C for 24 hours, as this may decrease chances of death and increase chance of neurologic recovery

Mild to moderate states of Hypothermia have been found to have a neuroprotective mechanism within the brain that can improve a patients outcome S/P Cardiac arrest

Therapeutic Hypothermia provides several brain preserving effects, however it also has associated complications that require attentive Nursing Care and Interventions to prevent complications from therapy.

Pathophysiology and Adverse Effects Cardiac Arrest Decreased perfusion (BP) Decreased Cerebral Oxygen delivery (causing neurological deficit) Cerebral Hypoxia Cerebral Edema Ischemia (Brain releases enzymes and experience intracellular ion changes that damage cellular mitochondria)

Pathophysiology Cont APOPTOSIS (pre-programmed cellular death) Anaerobic Metabolism occurs Increased Calcium Increased hyper excitability in the brain cells Exacerbation of Hypoxemic state Cellular Death Increased Cerebral edema

Pathophysiology Cont Blood Brain Barrier is Disrupted during low perfusion states Influx of fluid Worsening of Cerebral Edema

Hypothermia slows neuroexcitory processes, stabilizing the influx of Ca, limiting cellular death and reducing disruption in the blood Brain Barrier therefore decreasing cerebral edema

Apoptosis can last up to 48 hours after initial insult, which may explain why Therapeutic hypothermia is Neuroprotective.

Cooling patients limits the negative effects from hypoxemia Inducing mild hypothermia slows cerebral metabolism, decreasing Cerebral metabolic rate by 5-7%(20-28% reduction in cerebral metabolism when pt is cooled to 33C) for each degree Centigrade reduction in body temperature

Other Pathophysiology Therapeutic hypothermia suppresses ischemia induced inflammatory reactions Neutrophil and macrophage function decrease at temperature 2 for >5 minutes.Notify MD

Nursing Care of the Hypothermic Patient RNs must provide vigilant surveillance over the patients changing physical condition

Nursing Care Cont The RNs knowledge of Pathophysiology will require assessment of the following: Prevention of rewarming during the cooling phase Electrolyte imbalances Arrhythmia recognition Prevention of infection Skin Care Pain/ Sedation management

Prior to initiating hypothermia: Perform a complete skin assessment Assess response to pain Perform baseline Neurological exam: This is essential to allow for comparison after therapies, as well as some patients wakeup prior to cooling thus Therapeutic Hypothermia would not be an option

Once target temperature is reached, temperature needs to be maintained within target range (3234 degrees C) Temperature must be constantly monitored. Gaymar Mediterm III does this for you. It becomes a big thermometer!! Ensure cool air is not lost when performing nursing functions that may require removal of garments(this should be avoided at all cost) Must remove ice packs so temperature does not fall below 33c (20-25 minutes of application according to ECMC orders) Excessive cooling or overshooting the target temperature(