Theraputic Hypothermia
Hypothermia, defined as a core body temperature less than 95 °F(35°C) occurs
when heat loss exceeds the body’s heat production. (Ruffolo p.47) Thermal stability in
humans depends on the body’s ability to adapt to changes in internal and external
temperatures. Heat is transferred throughout tissues and fat, and is released at a rate
directly related to the temperature of the environment through radiation, conduction,
convection, and evaporation.
Hypothermia is typically seen as a bad thing; however, various studies have been
proving it to be very useful. Traumatic brain injury initiates several metabolic processes
that can exacerbate the injury. There is evidence that hypothermia may limit some of these
deleterious metabolic responses. In a randomized controlled trial researchers compared
the effect of moderate hypothermia and normhypothermia in 82 patients with severe
closed head injuries (score of 3 to 7 on the Glasgow Coma Scale) The patients assigned to
hypothermia were cooled to 33 degrees C an average of 10 hours after injury, kept at 32
degrees to 33 degrees C for 24 hours, and then re-warmed. A specialist in physical
medicine and rehabilitation who was unaware of the treatment assignments evaluated the
patients 3, 6, and 12 months later with the use of the Glasgow Outcome Scale. The
demographic characteristics, causes, and severity of injury were similar in the hypothermia
group and the normothermia groups. At 12 months 62% of the patients in the
hypothermia group and 38% in the normothermia had good outcomes (moderate, mild, or
no disabilities). The researchers concluded that “Treatment with moderate hypothermia for
24hours in patients with severe traumatic brain injury and coma scores of 5 to 7 hastened
neurological recovery and may have improved the outcome. (Marion et all)
Two studies done (one in Australia and the other in Europe) showed the
therapeutic value in survivors cardiac arrest. In the Australian study, which involved 77
patients who remained comatose after the restoration of spontaneous circulation, 49% of
those treated with hypothermia were discharged home or into a rehabilitation facility
compared to the 26% of those not treated with hypothermia. There were no significant
differe...
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...tion fluids, preparation solution, or baths can contribute to heat loss. Ruffolo
Evaporation is the transfer of heat to the air from moist skin or mucous
membranes. It occurs through wet skin, open body cavities and the respiratory tract.
References (Works Cited)
Ruffolo, Daria. www.rnweb.com. Vol. 65 No. 2. February 2002
Marion, DW et all. “Treatment of traumatic brain injury with moderate hypothermia”, University of Pittsburgh Medical Center.
Safar, Peter & Patrick Kochanek. “Therapeutic Hypothermia After Cardiac Arrest”. New England Journal of Medicine, February 21, 2002 p.612-613
Holzer, Michael. “Mild Therapeutic Hypothermia To Improve The Neurologic Outcome After Cardiac Arrest.” New England Journal of Medicine, February 21, 2002 p.549
Clifton, Guy et all. “Lack of Effect of Induction of Hypothermia After Acute Brain Injury” New England Journal of Medicine. February 22, 2002. p.556
Rose, Victoria. “Children Recover Faster Than Adults From Accidental Or Therapeutic Hypothermia”. www.docguide.com. July 23, 2001
Unknown Author, “Reducing Brain Temperature May Benefit At-Risk Newborns” http://www.pslgroup.com/dg/4E73E.htm, December 17, 1997
Maintaining normal core body temperature (normothermia) in patients within perioperative environments is both a challenging and important aspect to ensure patient safety, comfort and positive surgical outcomes (Tanner, 2011; Wu, 2013; Lynch, Dixon & Leary, 2010). Normorthermia is defined as temperatures from 36C to 38C, and is maintained through thermoregulation which is the balance between heat loss and heat gain (Paulikas, 2008). When normothermia is not maintained within the perioperative environments, and the patient’s core body temperature drops below 36C, they are at risk of developing various adverse consequences due to perioperative hypothermia (Wagner, 2010). Perioperative hypothermia is classified into three
The various modes of heat loss during this phase include radiation, convection, conduction and evaporation. Radiation contributes to maximum heat loss (approximately 40%) and is determined by the fourth power of difference between ambient and core temperature. Convection is the next most important mode of heat loss (upto 30%), and is due to loss of heat to air immediately surrounding the body. It is proportional to the square root of the velocity of the air currents. Evaporation contributes to less than 10% of heat loss and occurs from cleaning fluids as well as skin, respiratory, bowel and wound surfaces. Conduction accounts for least heat loss (upto 5%) and is due to cold surfaces in contact with the body such as operating room table. After 3-4 hours, a plateau phase is realized when core heat production equals heat loss to the periphery and core temperature reaches a
There is high risk of death and poor neurological function with unconscious survivors in out of hospital cardiac arrest. Trails were undertaken with the patients after awakening from cardiac arrest, which was compared with Ther...
I intend to explore the effects of a parietal brain injury from the perspective of a neuropsychologist; ranging from types of tests that are employed when trying to determine the extent of the damage, to gaining an understanding of how this damage will affect the rest of the brain and/or the body. I will also explore the effects of a brain injury from the perspective of the family members, and their experiences with the changes that occur during the rehabilitation process. According to The Neuropsychology Center, “neuropsychological assessment is a systematic clinical diagnostic procedure used to determine the extent of any possible behavioral deficits following diagnosed or suspected brain injury”(www.neuropsych.com). As mentioned previously, a brain injury can be the result of many types of injuries or disorders, thus a broad range of assessment procedures have been developed to encompass these possibilities.
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.
3. Childs NL, Mercer WN. Brief report: late improvement in consciousness after post-traumatic vegetative state. N Engl J Med 1996;334:24-25. (report of a 16 year old patient with PVS who recovered significantly after 17 months).
Did you know, that someone suffers from a brain injury every 21 seconds (Haas)? Children get concussions all the time, and most of the time they go unnoticed. The majority of concussions happen when one is playing a sport such as football, hockey, or lacrosse. Many famous athletes have had their careers, even their lives cut short due to concussions. Brain damage and death can result from serial concussions (Schafer). When one suffers from a concussion, one’s brain needs time to recover physically and mentally. Between 2002 and 2006, statistics showed that 52,000 people died from concussions and about 275,000 were hospitalized (Fundukian). Everyone’s recovery process is different (“Injury and Pain Care”). Although concussions seem minor, they are very serious brain injuries that may result in severe damage to one’s brain.
Thesis: Concussions affect children and adults of all ages causing physical, emotional and metal trauma to a person and their brain.
Yates, Keith, et al. “Longitudinal Trajectories of Postconcussive Symptoms in Children With Mild Traumatic Brain Injuries and Their Relationship to Acute Clinical Status.” Pediatrics. 123.3 (2009) : 735-743. Web. 11 Apr. 2014.
...l and cognitive function after severe traumatic brain injury. Journal Of Trauma & Acute Care Surgery, 73(2 Suppl 1), S165-72. doi:10.1097/TA.0b013e318260896a
The only result from the testing consistent with a brain injury was the abnormal pupil response of the right eye (constriction) (Traumatic brain injury, 2015). The physical effects that could have pointed to a brain injury were the laceration to the right side of the gentleman’s head and the amount of blood loss. The complaints from the patient that may have insisted a brain injury included a severe headache, dizziness, and nausea (Traumatic brain injury, 2015).
* Heat and Cold Therapy has been used for centuries to manage soft tissue and joint injuries while relieving pain.
Centers for Disease Control Injury Center May 30, 2007 Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths retrieved from http://www.cdc.gov/ncipc/pub-res/tbi_in_us_04/tbi_ed.htm
“John first took leftover prescription painkillers and numbed his left foot in ice water to reduce impending pain. He then buried his foot in dry ice for six hours to induce severe frostbite and force surgeons to operate” (Adams, 2007).
Stocchetti, N., Pagan, F., Calappi, E., Canavesi, K., Beretta, L., Citerio, G., … Colombo, A., (2004). Inaccurate early assessment of neurological severity in head injury. Journal of Neurotrauma, 21(9), 1131-1140. doi:10.1089/neu.2004.21.1131