Therapeutic hypothermia and temperature management
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Ther Hypothermia Temp Manag · Jan 2011
Can a Cold (4°C) IV Fluid Bolus to Induce Therapeutic Hypothermia Really Deliver 4°C to Children?
Induced therapeutic hypothermia after pediatric cardiac arrest is under investigation. Animal and adult data suggest that rapid achievement of temperatures (T) <34°C may improve outcomes. Cold intravenous fluids (IVF) rapidly induce hypothermia in adults. ⋯ Tbag
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Ther Hypothermia Temp Manag · Jan 2011
Induction of therapeutic hypothermia requires modulation of thermoregulatory defenses.
Hypothermia has been linked to beneficial neurologic outcomes in different clinical situations and its therapeutic value is considered important. For example, in asphyctic neonates and in patients with out-of-hospital cardiac arrest (with ventricular fibrillation as the initial cardiac rhythm), rapid installation of hypothermia has been reported to add substantial therapeutic benefits over nonthermal standard treatments. ⋯ This overview summarizes the body's primary reactions to hypothermia and the defense mechanisms available or evoked. Then, clinically applicable ways to overcome these forceful cold defenses of the body are described to ensure both an optimal induction process for therapeutic hypothermia and maximal subjective comfort for these conscious patients.
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Ther Hypothermia Temp Manag · Jan 2011
Use of therapeutic hypothermia in postcardiac arrest patients by emergency departments.
Since 2003, resuscitation guidelines have recommended the use of induced hypothermia as a therapy for patients who achieve return of spontaneous circulation after cardiac arrest from ventricular fibrillation. The aim of this study was to survey emergency physicians across the United States on their use of therapeutic hypothermia (TH) after cardiac arrest. An 18-question survey was e-mailed to a sample of emergency physicians. ⋯ A shivering protocol is used by 76% of respondents, and as a first line medication, 46% use benzodiazepines. For those who do not use TH or do not have a protocol in place, the reasons cited include "too expensive," "too difficult to implement," and "not enough science to warrant it." In this sample of practicing emergency physicians, TH after cardiac arrest is not being used as described in the original literature. Although awareness and implementation of TH have increased, there appears to be a wide variation in the application of this therapy.