post code hypothermia

[medicmade]

A near by county is doing a study with ems and the hospital to induse hypothermia after a pulse is retained from a code. If ems gets a pulse back they are to still go with the ACLS but also to pack the Pt in ice packs and run cold NS. The reciving hospital will continue with the effort and keep the body at 89 degrees. All this is to save the brain, has any one eles herd of this, it makes sence but its new to me.

[jdemaio]

Yea, I've heard of this...it makes sence, but it's kinda weird to think of intentionally making people hypothermic.

[anthonyt]

A near by county is doing a study with ems and the hospital to induse hypothermia after a pulse is retained from a code. If ems gets a pulse back they are to still go with the ACLS but also to pack the Pt in ice packs and run cold NS. The reciving hospital will continue with the effort and keep the body at 89 degrees. All this is to save the brain, has any one eles herd of this, it makes sence but its new to me.

read an article about it a while back... supposedly less cardiac demand as well.

[RichmondMedik]

The level one trauma center here in Richmond does it on a routine - I will see if I can get the papers to put online

[CornholioMedic]

I don't think this is the first time a study like this was done. I remember someone making mention of a study that was done within the past 10 years with refridgerated 0.9% saline.

[safdrookie]

Hey my supervisor just asked me to research post code induced hypothermia...anyone got any protocols or anything they can share?

[medic3]

Sure....
Indications: Age 16 or older
ROSC-With no purposeful movement to steral rub or response to
command 5 minutes into ROSC, and
Restored hemodynamic stability as defined by a systolic BP > mm Hg (with or without pressors) and a stable cardiac rhythm,
No pre existing hypothermia (<34C) and
Pt is intubated, If not intubated, initiate intubation per protocol
prior to initiating cooling.
Pt not a traumatic arrest.

Contra: Less than 16 yo.
Traumatic arrest, or
Hypothermia exists(<34C) by esophageal temperature probe, or Identified pregnancy, or
Audible rales/CHF

Methods: Post resus care as appropriate. Place esophageal thermometer
probe to establish baseline body temp
Place ice packs in groin, axilla, neck and torso
Establish at least 2 peripheral IV's or IO lines to infuse chilled NS
(2-4 degrees C) wide open in 500ml increments at 30ml/kg, not
to exceed 2L, monitor for PE/CHF. Target cooling temp to 32-34
degrees C.
Administer Ativan (2-4mg) and Vecuronium (0.1mg/kg)
Document vitals and temp q5min.
Notify recieving facility
Do not hyperventilate, monitor EtCO2/SpO2
Dopamine 2-20ug/kg prn
Obtain 12 Ld.
STEMI pts to PCI capable hospital

Hope this helps.

[medic pathetic]

We do it here also. As soon as i can get a hold of our protocol, i'll post it. We do the ice packs chilled saline. A hospital that we work our STEMI protocol in conjunction with has chilled blanket thing. We take rectal temps in the field on all arrest pts.

[stiffler1705]

i ve read several articles about this, although we dont do this at this time nor do i see us doing this in the near future. although i would like to c our main hospital do a study on it. i know alot of columbus ff's i dont believe there doing it either.

QT how about down there in delware county?

[Medic_QT]

QT how about down there in delware county?

Funny you should ask :biggrin:

http://www.ghettomedic.com/forum/showthread.php?t=6013



We talked about the relatively low overhead and people joked about stopping at 7-11 on the way to an arrest to get a couple of big gulps of ice, but honestly that's about it (Duh, we all know we don't have any 7-11's in delco). I'm kinda upset at the resistance we have to implementing it. The way I look at it, is certain "good ol boys" thought CPAP was a big stupid mask that isn't gonna do a damn thing. Well, now it's in our protocol and is widely accepted, and I for one, have a love affair with it.

One of Ohio State's docs wanted us to be one of the test departments for theraputic hypothermia post-ROSC, but we rarely ever tx there. I have three times since I started a year and a half ago--One trauma, and inhalation burns and CO (oooh btw we're getting the Rad's!!!! EEEEE!!! I'm excited!), and those have both been in the past 2 months. The only time we go there other than that is if someone requests OSU. For a post arrest we can't justify passing Grady, Riverside, St. Anns, and depending on the station, Dublin Methodist (That's 3 OhioHealth facilities and one Mt Carmel facility, if you're keeping count.. Our medical director is w/ OhioHealth.. That's another barrier to the study...)

However, we actually do practice this at the ER I'm part time with (Mt. Carmel East). We use cooling blankets and a rectal temp wire to monitor body temp. We only start the process in the ER, and by the time we get it underway, we're taking them to MICU.

Oh, btw. Do you know a M. Madeker? He works up in your neck of the woods. He's one of our part timers, and I worked w/ him today. He seems like a pretty nice guy.


Aaaaaaaaaand it's bedtime now. The locals have been restless now that it's warm, so wish me luck!!

[CombatMedic]

Medic in the making is right. My county (Nearby to them) is working on that type of protocol. I know that our capitol county (Wake) does it as part of their standard protocol. It has shown tremendous success.

Think Extended submersion in Icy cold water. Same concept

I will talk with my med Dir and see if he has any numbers.

[safdrookie]

thanks for the input everyone :)

[medic32]

4 weeks ago (or so) my partner and I (and the rest of B shift)worked a cardiac arrest, 56 y/o male. After 2 attempts at defribillation, intubation, and 1 round of epinephrine we had a a return of circulation, HR of 120, BP 152/80. He was starting to fight the tube a bit and I sedated him with 2mg of versed and transported him to our level 1 trauma center. 12 lead showed elevation in the anterior and lateral leads. He did never regain conscious or follow commands at the ED. Later that night he went to the cath lab and the following day they induced hypothermia. About a week ago he came walking into the firehouse with his wife with no brain deficit and he is returning to his full time job. This is my first time I have had a pt fit the criteria for this protocol but apparently it does have good outcomes. I don't know a lot about it besides the pt has to have a return of circulation from a vfib arrest. I know the cooling process is slow and that they are rewarmed at .5-1 degree an hour following 24-48 hrs of hypothermia. This is the protocol our hospital uses, unsure how it compares to others and again I myself do not know a lot about it. My first experience with had a great outcome.

[prncssmdc]

Not doing it in the field here, however, one of our ER docs put it into practice a few weeks back for the first time. The ER nurses freaked the f*ck out, that is right up until our medics educated them on the potential benefits of it. They then felt stupid (being shown up by a couple of "mere medics") and promptly shut up - which ultimately is what matters.

Btw, didn't help that particular pt - but atleast they can start moving in that direction and maybe help someone else.