I had a patient s/p cardiac arrest after aspirating from a nosebleed, intubated in the field. When it came down to the questioning of starting hypothermia, the nurse I got report from the doctor ruled it out because he was "biting the tube" and that was a sign of neurological activity.
Is that enough to exclude someone from TTM?
Mar 5, '17
Sigh... no it is not. It is a marker of someone who has some brain activity and is exactly the type of person that should be cooled. TTM is contraindicated in those who are following commands. We would cool even if they were moving their arms/legs. TTM will not save someone who is brain dead but it may be enough to keep someone who is marginal (biting the tube) and get them back to functional. It is sad when these patients do not get cooled and it always frustrated me when this happened. One thing I recommend is trying to get the doc to let you put the cooling gear on and use it to keep the pt at 37 degrees but not cool. Data shows that the avoidance of fever may be just as neuroprotective as cooling and might give the pt a better outcome than letting them spike a fever.
Mar 5, '17
"Biting the tube" is definitely not a reason to rule out TTM. If the patient was purposefully reaching for, grabbing the tube, and able to perform clearly purposeful movements then that would rule them out.
Mar 7, '17
I think the exclusion criteria is if the patient is verbal post rosc. So yeah the patient should've been placed on therapeutic hypothermia.
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