Hypothermia pts.

[Rene24]

I just accepted a position in CCU (a medical cardiac icu) and have been on cardiac surgical step down floor for the past two years. In our CCU we induce hypothermia for the post MI/Cardiac arrest patients who would benefit from it. I was wondering if anybody could explain what all is involved as far as nursing care, what the RN actually does, what scares you - what to watch out for. I know there are tons of drips and protocols and would love to have more info. Thanks!

[shocker29]

Hypothermias are fun, if done on the right patient. These patients are a 1:1 in our unit until they are warm again. (Supposed to be a 2:1 while inducing, but that never happens anymore.) We have a central line that can be placed that is actually a cooling catheter. If we can get the doc to insert the line, then this machine circulates ice water and cools the patient. In that case, we assist the doc with insertion and set up the machine. If we don't use the cooling cath, then we have to ice pack the person and ice lavage them down their NG/OG tube. It's way easier and less time intensive if you have the cooling cath. The patient is paralyzed, so we are doing peripheral nerve stimulation hourly to q2 hrs to make sure the patient is not over paralyzed. They are also obviously vented and sedated, so we monitor their BIZ to make sure they are not waking up. We keep them at the target temp for 24 hours (32-34C) and then stop cooling and let them passively rewarm. The big thing to watch for is dysrhythmias, especially when they are cold. If you are icepacking manually, it is really important that you watch for "drifting".... the patients temp can dump very quickly and every point under 32C, you majorly increase your dysrhythmia risk. When you start re-warming the patient, they dilate out and get can hypotensive quick, so usually pressors are part of the order set. It all kind of depends whats going on.

We have seen some truly amazing success stories. However, patients are often induced now that don't meet the criteria and we are doing this on some patients that never had a chance. Hypothermia is supposed to be indicated after a witnessed v-fib/V-tach arrest, in which CPR was started within 5 minutes. I understand going outside of this criteria for lots of things, but we are getting patients who were down for an indeterminate amount of time, and were pretty much DOA with a heartbeat and 3 days later they are the same. That's a physician issue... it goes between docs wanting to give everyone a chance and docs afraid of getting sued.... I don't know. Anyways, amazing recoveries lots of times. :) Hope this helps. I like hypothermias :)

[Rene24]

Thank you so much!! That was really helpful, and if anyone else is interested I found a hospital protocol for hypothermia http://www.med.upenn.edu/resuscitation/hypothermia/documents/Penn_Post-CardiacArrestCareHypothermiaOrderSet011309v2.pdf, they are located in PA but it was very similar to what i've heard from others and gives you an idea of the drips and procedure.