The purpose of this paper is to review and evaluate two recent studies, published within the last 5 years, conducted on mild therapeutic hypothermia induction in relation to the cardiac and vascular circulation. One article tested and evaluated the effects of mild hypothermia therapy on patients with cardiogenic shock after resuscitation from an out-of-hospital cardiac arrest. The other study provides some insights on hypothermia therapy on cardiac index of postoperative cardiac surgical patients after iced and room-temperature injectates during hypothermic and normothermic body temperatures. Furthermore, since prior studies have concluded that mild hypothermia inductions contributed to improving long-term neurological outcomes, each article discusses the significant benefit of utilizing therapeutic hypothermia, specifically in increasing survival rate after an out-of-hospital sudden cardiac arrest.
According to Joint Commission in 2011, over 290,000 people in the United States experience sudden cardiac arrest each year. The survival rate of victims remains low, and the risk for recurrence yet remains a significant concern for most survivors, where only 7%–8.5% survive (Joint Commission, 2011). If resuscitation efforts fail to restore cerebral blood circulation within minutes of cardiac arrest, hypoxia may lead to permanent brain injury. Even if circulation is restored, secondary brain damage can occur from direct tissue injury or blood–brain barrier disruption (Michelle et al, 2011). Thus, in an attempt to improve survival rates, prevent permanent neurologic injury and reduce mortality for survivors of cardiac arrest, clinical experiments have shown that a mild hypothermia state of about 32°C to 34°C reduces metabolic and oxygen...
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...and how. American Nurse Today 6(7). Retrieved from http://www.americannursetoday.com/article.aspx?id=8014&fid=7986
Joint Commission (2011). Sudden cardiac arrest: Meeting the challenge. Retrieved from http://www.jointcommission.org/assets/1/6/Sudden_Cardiac_Arrest-final_2.pdf
Walsh, E., Adams, S., Chernipeski, J., Cloud, J., Gillies, E., Fox, R., Luckeroth, P. Rice, M., Salamanca, C., Sherman, B., Nezworski, A., & Ash, T. (2009). Iced vs room-temperature injectates for cardiac index measurement during hypothermia and normothermia. American Journal of Critical Care 19(4), 365-372. http://dx.doi.org/10.4037/ajcc2009255
Zobel, C., Adler, C., Kranz, A., Seck, C., Pfister, R., Hellmich, M., Kochanek, M., & Reuter, H. (2012). Mild therapeutic hypothermia in cardiogenic shock syndrome. Critical Care Medicine, 40(6), 1715-1723. http://dx.doi.org/10.1097/CCM.0b013e318246b820
This essay will discuss the risks for patients during the preoperative, intraoperative and postoperative stages of the perioperative journey and how both patients and healthcare professionals involved in the perioperative stages can work together to prevent perioperative hypothermia.
Inadvertent perioperative hypothermia is a common anesthesia-related complication with reported prevalence ranging from 50% to 90%.(ref 3,4 of 4) The clinical consequences of perioperative hypothermia include tripling the risk of morbid myocardial outcomes and surgical wound infections, increased blood loss and transfusion requirements, and prolonged recovery and hospitalization.(ref 5)
Sepsis is a problem of bacterial, parasitic and fungal infections. Due to this, the body develops a systemic immune response to get rid of the infection or tissue damage. This causes inflammation throughout the body, mainly found in small blood vessels or it leads to septicaemia which is where microbes or infections are found in the blood; this can also be called blood poisoning. Septic shock is a life-threatening condition where hypotension occurs as blood pressure drops to a dangerously low level after an infection. In septic shock the patient may experience tachyeordia, this is where there is a greater heart beat than normal (90 heart beats a minute) and tachypnae where the patient is breathing faster than the normal rate (12-20 breathes per minute).
The guidelines’ first focus is the definition of sepsis, which makes sense, because there is no way to effectively treat sepsis without an accurate and categorical definition of the term. The guidelines define sepsis as “the presence (probable or documented) of infection together with systemic manifestations of infection”. Such systemic manifestations can include fever, tachypnea, AMS, WBC >12k, among others; these manifestations are listed in full in Table 1 of the guidelines. The definition for severe sepsis builds on to the definition of sepsis, bringing organ dysfunction and tissue hypoperfusion (oliguria, hypotension, elevated lactate) into the picture; full diagnostic criteria is listed in Table 2. The guidelines recommend that all
Targeted Temperature Management at 33 degree versus 36 degree after Cardiac Arrest (Neilsen et al)
The first was to see how long it would take to lower body temperature, and the next to decide how best to resuscitate a frozen victim. The doctors submerged a naked victim in an icy vat of water. They would insert an insulated thermometer into the victim’s rectum in order to monitor his or her body temperature. The icy vat proved to be the fastest way to drop the body’s temperature. Once the body reached 25 degrees Celsius, the victim would usually die.
...1, February). Preprocedure warming maintains normothermia throughout the perioperative period: A quality improvement project. Journal of Perianesthesia Nursing, 26(1), 9-14.
Prisoners were subject to freezing experiments as scientists looked for an effective treatment for hypothermia. Scientists also wanted to discover how long German pilots downed by enemy fire could survive the frozen waters of the North Sea. Some were forced in a tank of ice water at sub-zero temperatures for up to five hours. Others were left outside to freeze in the winter cold. Numerous victims lost consciousness and died when their body temperature dropped to 25 degrees Celsius. It was also found that humans could not survive immersion in the North Sea for more than two hours. By studying the effects of this cold exposure and meticulously noting the changes in the subject’s body temperature, heart rate, and muscle response...
The American Heart Association gives sufficient evidence for the need of change by acknowledging that sudden cardiac arrest is a leading cause of death (2012). These fatalities affect both adult and child victims. Statistics also show that 70% of people feel helpless during a cardia...
Wilson, W., McGrande, C and Hoyt, D. (2013) Trauma: Emergency Resuscitation, Perioperative Anesthesia, Surgical Management, Vol 1, CRC Press: New York
This theory supports the practice of viewing and caring for each patient as a total human being, instead of individual parts. It acknowledges that the human being and his/her surrounding environment are as one. The environment affects the thoughts and actions of the individual. If the environment is altered, so will the status of the individual. Possessing a healthy emotional and physical state of health and personal environment is necessary for positive outcomes and goals to be achieved and sustained throughout life. The initiation of bystander CPR depends on the knowledge and skills of the individual and surrounding environment. Acquiring the mental knowledge of the importance of the skill and taking the initiative to learn and initiate the physical technique of CPR is of utmost importance when striving for and increased survival rate of patients who undergo cardiac arrest. Existing in and educating the environment of proper technique and mortality rates can also increase the likelihood of patient
Sepsis is defined as an exaggerated, overwhelming and uncontrolled systemic inflammatory response to an initially localised infection or tissue injury, which may lead to severe sepsis and septic shock if left untreated (Daniels, 2009; Robson & Daniels, 2013; Dellinger et al, 2013; Perman, Goyal & Gaieski, 2012; Vanzant & Schmelzer, 2011). Septic shock can be classified by acute circulatory failure as a result of massive vasodilation, increased capillary permeability and decreased vascular resistance in the body, causing refractory hypotension despite adequate fluid resuscitation. This leads to irreversible tissue ischaemia, end organ failure and ultimately, death (McClelland & Moxon, 2014; Sagy, Al-Qaqaa & Kim, 2013, Dellinger et al, 2013).
to determine why athletes suffer sudden cardiac arrest, and although there have been a fair amount of conclusions, none have been clear and strong enough to determine why exactly they occ...
Sepsis is a life threating health condition and if not treated early can lead to shock, multiple organ failure and death (Ho, 2012). The main study of which practice has been based world-wide is the Surviving Sepsis Campaign. The Surviving Sepsis Campaign was developed to create evidence-based management guidelines. The Surviving Sepsis Campaign completed this by using an educational program to implement the guidelines by integrating their recommendations into resuscitation and management bundles (Marik, 2011). The first Surviving Sepsis Campaign Guidelines were published in Critical Care Medicine in 2004 with an updated version published in 2008 with the core of the recommendation's remained largely unchanged (Ahrens, 2011).
Anesthesiologists have many responsibilities. 3They measure the patient’s temperature, pulse, heart rate, and breathing rate while under the sedative. They have...