Therapeutic hypothermia
The use of Therapeutic hypothermia for treatment of patients with potential ischemia has been around for around for about 70 years. After fading into and out of popularity for the past half century, therapeutic hypothermia has reemerged as a state of the art lifesaving tool in the fight of a potentially hypoxic brain injury. Even though the evidence to the support this treatment is growing, more research is needed to decide if this treatment will become the new standard of care for these patients, or if it will fall by the wayside. In the past 25 years EMS has gone under drastic changes in the way that we treat patients, with cutting edge emergency medicine and state of the art equipment and with months of detailed and in depth training, todays paramedic is well equipped to handle every medical emergency they can encounter. But, even though all of these advances have been made, the chance of a patient making a full recovery following an out-of-hospital cardiac arrest is extremely low.
It is generally known that the brain does not respond well to that of hypoxic events, most all situations the golden 5-7 minutes ‘point of no return rule’ still is acknowledged, but a large part of the problem is that fact that brain damage will continue to occur for several hours following resuscitation, just because the heart begins beating again does not mean that ischemia has stopped. One study shows that while 17 -25% of cardiac arrest patients survived to hospital admission, only 4-9% (Bernard) left the hospital neurologically intact. Some research has shown, however, that therapeutic hypothermia can help increase the odds of these patients regaining 100% of neurological function by the time that they leave the hospital...
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... immune system response, hypoglycemia, hyperkalemia, a generally lower cardiac index, a high risk of hospital acquired pneumonia secondary to the decrease immune system response, impaired clotting factors, and shivering from the patients that could negate the therapy itself
The EMS role in therapeutic hypothermia is that of much importance, who is the first one on scene with these patients? Nine times out of ten EMS is by the patient’s side within minutes and who better to start this therapy than those of paramedics. The use of hypothermic fluids usually must continue for a minimum of 12 hours following a sudden cardiac arrest. And seeing as how the potent effects of therapeutic hypothermia can be decreased by withholding the treatment even a matter of minutes, EMS is by far in the best position to begin the treatment in the field, before arriving at the hospital.
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)
When a patient is declared brain dead because a code cart was not properly stocked, this is a serious issue and needs to be addressed. When a physician is done utilizing the code cart, there should be an individual appointed to ensure that it has been properly restocked for the next physician who needs it. Failure to confirm that all items that have been used are replaced again, does have an effect in the quality of treatment the patient receives. Whether the time it takes the individual to locate and replace that item during an emergency is seconds or minutes, time is a major factor in the patients’ health. As in our case, the patient’s care was prolonged by 3-minutes that indisputably resulted in her death (Pozgar, 2016, p.
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...
Hypovolemic shock specifically disrupts the cardiovascular system from a significant loss of blood volume that causes blood pressure to deplete and oxygen delivery to cells to slow. A victim entering into hypovolemic shock will experience three sequential stages as the body attempts to maintain homeostasis. These stages are named compensated, decompensated, and irreversible (Wang
Featherstone, P., Prytherch, D., Schmidt, P., Smith, G. (2010). ViEWS: towards a national early warning score for detecting adult inpatient deterioration. Resuscitation, 81(8), 932-937.
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...
problems within the specific ion channels known to cause the disease. The goal of the
The brain stem is also able to carry out these actions even when someone is asleep. To fully understand how crucial the brain is to survival, one must understand the functions of the brain stem. Brain death occurs when brain cells, which cannot regenerate themselves, are injured or dead. This results in brain death as the brain becomes starved of oxygen. One can only be pronounced brain dead, by a neurologist and even then, a number of criteria must be met, some of these include; unresponsiveness to stimuli; no reflexes and an inability to breathe unaided by a machine (Goila and Pawar, 2009).
The World Health Organisation (2013) explains that an Ischaemic stroke occurs as a result of a blood vessel becoming blocked by a clot, reducing the supply of oxygen to the brain and, therefore, damaging tissue. The rationale for selecting Mary for this discussion is; the author wishes to expand her evidenced based knowledge of stroke since it is the principal cause of disability and the third leading cause of mortality within the Scottish population (Scottish Intercollegiate Guidelines Network (SIGN), 2008) and, therefore, a national priority. In response to this priority, the Scottish Government (2009) produced their ‘Better Heart Disease and Stroke Care Action Plan’. Additionally, they have introduced a HEAT target to ensure 90% of stroke patients get transferred to a specialised stroke unit on the day of admission to hospital (Scottish Government, 2012).
Nobody is perfect. We all make mistakes. Some of the best lessons in life are learned from making a mistake. But in the healthcare world making mistakes means losing lives. This has started to happen so frequently there has been a term coined – Failure to Rescue or FTR. Failure to rescue is a situation in which a patient was starting to deteriorate and it wasn’t noticed or it wasn’t properly addressed and the patient dies. The idea is that doctors or nurses could’ve had the opportunity to save the life of the patient but because of a variety of reasons, didn’t. This paper discusses the concept of FTR, describes ways to prevent it from happening; especially in relation to strokes or cerebrovascular accidents, and discusses the nursing implications involved in all of these factors.
So that, the diagnostic and therapeutic course of management should have been commenced sooner. Contacting other therapeutic members and explaining the situations to different people including nurse manager, consultant, senior registrar and anaesthetists have delayed the management. However, I believe that my action benefitted the patient and his family by avoiding further delay in the management. And also, ensuring the presence of a staff member with Michael’s wife should have assisted her to go through the unforeseen situation. I understand the neurological deterioration of GCS >8 and respiratory distress are indications of intubation of neuroscience patients. However, intubation is also indicated for therapeutic and diagnostic procedures in aggressive and uncooperative patients (Souter & Manno 2013). This scenario highlights the importance of the person-centred approach to clinical judgement and decision
...epending on the patient’s dehydration, therefore also affecting the patient’s tonicity. The patient would also be losing water insensibly, in an unperceived way through their skin and lungs (Martini). This could be combative with the patient experiencing shortness of breath, in order to preserve some water from evaporating. In order to maintain proper osmolarity, the intercellular fluid would loose water to the extracellular fluid. This patient would need the replace the fluids he has lost by drinking water, or through intravenous isotonic crystalloid. I would suggest intravenous isotonic crystalloid since it would restore the body to homeostasis much quicker than through drinking. It is important that fluid balance, membrane transport, and overall homeostasis be maintained, for the longer the body is out of homeostatic range, the more detrimental the effects will be.
“Summary Report for: 29-2041.00 - Emergency Medical Technicians and Paramedic.” O*Net. 2008. Web. 18 Feb. 2010.
it, only slow it down. In the first stages the drugs are very successful. and the patient is kept in relatively good health. In the final stages However, drugs are almost completely unsuccessful and the only thing that can be done for a patient is to make him comfortable with easing drugs. They are a good choice.