Advanced life support modifications

• Advanced life support should be initiated according to the universal algorithm (see Chapter 6).

Table 13.3 Definitions of rewarming.

Passive rewarming

Active external warming

Active internal warming

Achieved with blankets and a warm room. This method alone will not be effective for patients in cardiac arrest or severely hypothermic Heating devices (e.g. bair huggar), warm bath water or radiant heat. Use caution since some heating devices can cause tissue injury Warmed, humidified oxygen, peritoneal, gastric, pleural or bladder lavage with warm fluid (40°C), intravenous administration of warmed fluids (e.g. normal saline). Follow local hospital policy

All hypothermic patients

Mild and moderate hypothermia

Severe hypothermia

• Arrhythmias - procedures such as endotracheal intubation can cause VF. However, this should not be withheld when urgently indicated.

• Defibrillation - if the core temperature is <30°C, VF may not respond to the first three shocks. Further shocks should be delayed until the patient's body core temperature is >30°C. Continue CPR during this time (AHA & ILCOR 2000).

• Drugs and drug administration - where possible, a central or large proximal vein should be cannulated. The casualty with hypothermia may not respond to cardioactive drugs. Drug metabolism is reduced and this may lead to a build-up of drugs in the system. Epinephrine (adrenaline) and other drugs are generally withheld until the temperature is >30°C. Once this target is reached, the intervals between doses should be doubled and the lowest recommended dose given. Once the temperature is near normal, standard drug protocols can be used (AHA & ILCOR 2000).

Death is not confirmed until the casualty is warm or attempts to raise core temperature have failed. A full recovery without neurological deficit may be possible even after prolonged hypothermic cardiac arrest (Resuscitation Council UK 2000).

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