Therapeutic Hypothermia Summary

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.

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.

Original research related to sedation management occurred in the year 2000 by Kress, Pohlman, O ' Connor, and Hall. Their findings served as a landmark study and initiated the impetus related to improving our sedation practices. According to Kress et al. (2000), daily interruption of sedation led to a decrease in the number of days on the ventilator in the intensive care unit. Several studies since this time have focused on the influence of sedation protocols, and outcomes. This paper will review the synthesis of the discovered studies and highlight the noted contraindications and inconsistencies. Also, explanations including a preliminary conclusion will be discussed.

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).

It is a beneficial treatment that should be implemented as early in patient care as possible, such as, within the EMS system. Through the last century this therapy has been accepted and rejected by many medical professionals. Since medicine is an ever-changing field, future research and practice of hypothermia will dictate if this therapy is more beneficial than harmful, and maybe one day could be a permanent major role, or it may never be used again. Hypothermia has been proved to decrease neurological impairment after cardiac arrest, but also has many limitations that can occur. A major limitation of this therapy is, if continued care cannot be guaranteed by receiving hospitals, therapeutic hypothermia is irrelevant for EMS to initiate. Likewise, if hypothermia is not begun in the field by EMS, then the receiving facilities now will have a delayed time in starting the therapy and anoxic brain injury could have already occurred. EMS agencies can drive the implementation of therapeutic hypothermia in the medical field. This therapy allows EMS providers to have a major role in the outcome of a cardiac arrest patient’s recovery and neurological outcome. With the progression of research and practice, medicine is evolving day after day, and patient mortality and morbidity have decreased over the years. Although, cardiac arrest patients have a poor

hypertension. Therapeutic hypothermia (THT) has been considered an effective method for reducing ischemic injury of the brain due to cardiac arrest. But there are some opponents in the medical community who believe that broadening the scope of THT could be dangerous to patients. Although opponents do not seem to blame THT for adverse patient outcomes; the disagreement seems to be about the variables involved before hospital arrival, amount of time that it takes to administer THT in the ER, which therapies should be administered with THT and the need for more research that tracks adverse events. A study published by The American Journal of Emergency Medicine supports the widely held view that THT is an effective treatment for cardiac arrest

The lack or delay in appropriate treatment for individuals who experience a sudden cardiac arrest has created a major public health disparity. Research into pre-hospital treatment and subsequent implementation has historically seen neglect by the medical and scientific community creating vast differences in survivability of cardiac arrests between demographic groups. In 2010, the American Heart Association and Emergency Cardiovascular Care program developed the 2020 impact goal to reduce death from cardiovascular disease and stroke by 20% and double out-of-hospital cardiac arrest (OHCA) survival rates (http://circ.ahajournals.org/content/121/4/586#sec-1). This has prompted a massive influx of research into the disparities that exist and an

Markus Thalmann, the cardiac surgeon who saved the little girl from death by drowning in icy water, said that she was not the first hypothermia and suffocation case. However, she was the first one to survive. In her complicated rescue they tried to follow a checklist that stats that in such a case, a rescue team was required to tell the hospital to prepare for possible cardiac bypass and rewarming. So, what was so effective about this approach is that by the time the patient gets to the hospital, everything is ready and standing by. These kinds of cases are time sensitive. In such complicated cases, success requires having a huge number of equipment and people at the ready. So, even small simple checklist could help in complicated rescues and even bring people to life

This paper will be going over a scenario involving a real patient and what things could have been different with EMS care. It will also be covering what exactly cardiac arrest is and what rhythms produce it. And for every cardiac rhythm in cardiac arrest, there is a specific treatment plan paramedics can follow.

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 nursing topic that I am going to base my final paper on is the use of hypothermia therapy following the successful resuscitation of adult patients. I want to further understand the positive or the negative outcomes for patients after we have using the hypothermia therapy protocol. hypothermia _1_.pdf This is one of the research studies that I plan on using in the research for my finial paper. The PICO question that I will be trying to answer in my research paper will be " In the resuscitated adult patient does the use of hypothermia therapy have a reduced mortality rate for adult patients after they have been discharged from the hospital?" By using the definition of PICOT from our book, the P in my research is resuscitated adult patients,

Therapeutic hypothermia, also called targeted temperature management, is a procedure that lowers the body's temperature in order to treat a heart that has suddenly stopped working (cardiac arrest). This procedure is used in emergency situations. During cardiac arrest, the brain cannot get enough oxygen. The brain also starts to swell, which can damage or kill brain cells. Therapeutic hypothermia helps reduce swelling in the brain. It also slows down the body's metabolism and allows the heart and brain to recover.

Malignant hypothermia is a disease, caused by a bad reaction of anesthetics. This disease causes an immensely rapid temperature rise and extreme muscle contractions. MH (malignant hypothermia) is passed down through families and inherited by one parent carrying it giving it to the child. “Malignant hyperthermia occurs in 1 in 5,000 to 50,000 instances in which people are given anesthetic gases” (NIH, 2007). Most people aren’t aware that they are prone to this disease/reaction because they have never been under anesthesia drugs, or have never received surgery.

WEEK 5 PICO(T) QUESTION 1Good Afternoon Class and Dr. Stephenson,In and out of the hospital high quality cardiopulmonary resuscitation (CPR) is crucial to survival of victims of cardiac arrest. This research topic will focus on implementation of in hospital chest compressions in CPR. It will be based on a comparison of the efficacy of manual compressions and automated chest compressions in relation to survival outcomes. The potential attributes and short comings related to manual and automated chest compression will be reviewed. Intensive care unit (ICU) nurses have to be prepared to implement CPR during a cardiac arrest code. In consideration that patients in the ICU are often only marginally stable it is important that ICU nurses are familiar with their patient’s recent and past medical histories.

A Do not resuscitate (DNR) order is a legal document written by a licensed physician, which is developed in consultation with the patient, surrogate decision maker, and attending physician. This document indicates whether the patient will receive resuscitative care, cardiopulmonary resuscitation (CPR), or advanced medical directives, in the setting of cardiac and/or respiratory arrest. A DNR can also be referred as a no code when identifying a patient’s resuscitation status. If a patient has an existing DNR it allows the resuscitation team, taking care of the patient, to either withhold or stop any resuscitation measures, and therefore respect the patient’s wishes. Historically, DNR orders did not become active in the care of patients until 1974, when it was identified that patients who received CPR, and survived, had significant morbidities (Braddock & Derbenwick-Clark, 2014). Braddock and Derbenwick-Clark further noted, the American Heart Association (AHA) recommended that physicians, in consultation with the patient, family, and or surrogate, place on the patients chart when CPR was not indicated. This documentation is now what we refer to as the DNR order and has become the standard to allow autonomous respect for patients, and their families, to make informed medical decisions. Therefore, the purpose of this paper is to discuss the legal aspects, ethical issues, and the application surrounding the DNR order.