Therapeutic Hypothermia
Introduction
Therapeutic hypothermia is deliberately reducing core body temperature in a patient after a cardiac arrest. Therapeutic hypothermia slows cerebral metabolism to reduce the need of oxygen to allow the brain to rest and return to normal function (Deckard. 2011). Irreversible neurological damage and death are common outcomes after cardiac arrest, even after resuscitation is initiated (Erbs. 2012.p. 38). Implementing therapeutic hypothermia shortly after a cardiac arrest can improve the outcomes of neurological damage and reducing risk of death.
Possible Ethical Concerns
Ethical concerns related to therapeutic hypothermia is the respect for autonomy, right to self-determination, advance directives and living
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Nurses must balance the benefits versus the risk of treatment. Therapeutic hypothermia has been proven to improve the neurological damage and reduce the risk of death post cardiac arrest (Avery. 2015. p. 30). Even though a patient cannot consent to this treatment; it does improve their outcome after a cardiac arrest. The American Heart Association’s 2010 guidelines recommended initiating therapeutic hypothermia as soon as possible after return of spontaneous circulation [ROSC] (American Heart Association. 2016). Therefore, initiating therapeutic hypothermia benefits outweigh the risks of the patient post cardiac arrest. Given the patient is unconscious and unable to consent to this treatment; all patient deserves the right to life. Nurses responsibility is to the patient; to promote health and well-being, prevent injury or illness, restoration of health, alleviate pain and suffering and to provide supportive care (ANA. 2016. p. 2). Therapeutic hypothermia can assist in the promotion and restoration of health, providing supportive care, alleviating pain and suffering. This procedure was initiated at my place of employment last year and we have seen great results after implementing this technology into practice for post cardiac arrest patients. This student believes that nurses should do everything possible to preserve the life of their
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)
Not all cases is patient autonomy the most important thing to respect and honor. There will always be situations where Medical paternalism is justified. Justifiable paternalism in a medical perspective is prolonging patients’ lives allowing them to exercise their autonomy. Failing to respect a patient’s treatment requests or denials is a violation of the autonomy at that point in time during their illness. While the previous statement is true, the medical professional is violating a patient’s future autonomy. For this reason, medical professionals have the right to act paternalistically, therefore medical paternalism is justified by means of future autonomy and obligations to promote patient
As a result, life-sustaining procedures such as ventilators, feeding tubes, and treatments for infectious and terminal diseases are developing. While these life-sustaining methods have positively influenced modern medicine, they also inadvertently cause terminal patients extensive pain and suffering. Previous to the development of life-sustaining procedures, many people died in the care of their own home, however, today the majority of Americans take their last breath lying in a hospital bed. As the advancement of modern medicine continues, physicians and patients are going to encounter life-altering trials and tribulations. Arguably, the most controversial debate in modern medicine is the discussion of the ethical choice for physician-assisted suicide.
The boundaries of right to die with dignity are hard to determine. Keeping the terminal patient comfortable is the purpose of comfort care, however there could be a very thin line between what we consider terminal sedation and euthanasia. In theory, comfort care is quite different from euthanasia. Keeping the patient comfortable and letting the nature take its course is at the core of comfort measures (Gamliel, 2012). Yet, the line between keeping comfortable and facilitating death is often blurry. Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering (Gamliel, 2012). The purpose of this paper is to highlight the ethical issue of keeping comfortable vs. hastening death, and the ethical principles involved. Facilitating or hastening death is considered unethical or even illegal.
Targeted Temperature Management at 33 degree versus 36 degree after Cardiac Arrest (Neilsen et al)
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
However, this approach not only lacks objectivity, but it also fails to acknowledge the abnormal physiology that precedes this breakdown in self-care. For instance, it has been reported that 70% of patients preceding cardio-pulmonary arrest had a physiological decline in respiratory or mental function (Schein et al 1990). Observing deterioration in activities of daily living alone does not accurately mirror underlying physiological deterioration occurring in patients.
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...
Autonomy is a concept found in moral, political, and bioethical reasoning. Inside these connections, it is the limit of a sound individual to make an educated, unpressured decision. Patient autonomy can conflict with clinician autonomy and, in such a clash of values, it is not obvious which should prevail. (Lantos, Matlock & Wendler, 2011). In order to gain informed consent, a patient
There are many ethical dilemmas in the medical field, especially when it is related to patient’s autonomy; an example to this is euthanasia. Many patients prefer to go over this procedure before continuing suffering from a terminal illness. However, many people to this day believe that this is an unethical practice to perform.
In this diverse society we are confronted everyday with so many ethical choices in provision of healthcare for individuals. It becomes very difficult to find a guideline that would include a border perspective which might include individual’s beliefs and preference across the world. Due to these controversies, the four principles in biomedical ethic which includes autonomy, beneficence, non-maleficence and justice help us understand and explain which medical practices are ethical and acceptable. These principles are not only used to protect the rights of a patient but also the physician from being violated.
Mohr, M., & Kettler, D. (1997). Ethical aspects of resuscitation. British Journal of Anaesthesia, 253.
Neonatal resuscitation is intervention after a baby is born to strengthen it’s breathe or to boost its heartbeat. Approximately 10% of neonates require some assistance to begin breathing at birth, but only 1% require serious resuscitative measures. Informed consent regarding neonatal resuscitation is a constant ethical debate. This discourse ordinarily occurs between doctors and parents; parents often feel that the decision has been made for them, believing that they were not fully informed of any consequences that may occur before making their final action plan, or thinking that their opinion was not taken seriously; however, doctors see the procedure in a different light, that the parents can’t choose the best option for the child regardless of counseling, or performing as the parents wished but believing that the result could have differed if the parents had known all the effects that it will have further down the line, or convinced that they would have made a better
The University of Pittsburgh Medical Center uses a protocol for cardiopulmonary death in which they declare the patient dead after two minutes of cardiac arrest.1 This has become controversial because some critics argue patients could be resuscitated at the two minute mark, therefore the patients have not experienced irreversible loss of function and are not truly dead.1 In the event of organ donors, this violates the dead donor rule, which states that the patient must be dead in order to harvest organs.1 However, their council’s rebuttal states that ethically a patient has irreversibly lost function if the patient wishes to be free from life...
If a person stops breathing, or their heart stops beating effectively, the purpose of this lifesaving technique is to keep oxygenated blood flowing around the body to keep vital organs alive (Finger Lakes Donor Recovery Network). Cardiopulmonary resuscitation is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which a person’s breathing or heartbeat has stopped. The American Heart Association recommends that everyone — untrained bystanders and medical personnel alike — begin CPR with chest compressions. If you're not trained in CPR, then provide hands-only CPR. It is far better to do something than to do nothing at all even if you are fearful that your knowledge or abilities are not one hundred percent complete. (Mayo Clinic, 2017). Acting versus inaction could be impact whether a person lives or dies. According to national statistics, less than thirty percent of people who experience cardiac arrest outside of a hospital receive bystander cardiopulmonary resuscitation (CPR Statistics). CPR itself will not restart someone’s heart, but may keep them alive until a defibrillator arrives (Science Forums, 2012). The American Heart Association teaches rescuers to practice C-A-B: chest compressions first, then airway and breathing. By starting chest compressions first, the patient only has