Acute Care 20: Therapeutic Hypothermia
After Cardiac Arrest
Referring
Physician Workup
(Adapted from Glencoe Regional Health Services—Minnesota)
Date: _________________ Time of arrest: __________________ ED
arrival time:
_____________________
Referring physician: ________________________ Contact Number:
________________________________
| Inclusion Criteria | Exclusion Criteria |
| Non traumatic cardiac arrest | Comatose or vegetative state before arrest |
| Cardiac
arrest < 60 min from collapse to return of spontaneous circulation (ROSC) |
DNR/DNI |
| Unresponsive
S/P arrest; no response to verbal commands |
Active bleeding |
| PEDS: For pediatric patients,
consult with cardiologist. |
SBP
< 90 for > 30 minutes after ROSC despite use of vasopressors |
| Obtain 12-lead ECG to evaluate for Level 1 STEMI | |
| CONTACTS | |
| 1-Contact your referral hospital and page the cardiologist to determine if the patient is COOL-IT/Level I STEMI or COOL-IT only. 2-Call Dispatch to activate the transport team. 3-Call for air/ground transport. | |
| Stabilization | Time Completed |
| Patient
intubated with 2 large bore IVs in place, on cardiac monitor |
|
| Obtain core temperature and document here | |
|
Remove all clothing (gown only). Avoid sheets and blankets. |
|
| Apply ice packs to the neck, axilla, and groin | |
|
Attach hands-free defibrillation pads and obtain labs |
|
| Document
cooling measures and record core temp every 10 minutes |
|
|
Place OG tube, if able, sedate with Ativan and Versed. |
|
|
Use paralytics as needed to prevent shivering |
|
|
Check ETT placement per hospital facility routine. |
|
|
COOL-IT/Level 1 STEMI Medication Protocol (arrival at CV Lab) |
Time Completed |
| Aspirin 300 mg rectally | |
|
Heparin loading dose of 60 units/kg (max 4000 units IVP) |
|
|
Heparin continuous infusion at 12 units/kg/hour (max 1000 units/hr) |
|
|
Plavix 600 mg per OG tube, if placement verified per abdominal x-ray. Do not delay transfer to referral hospital. |
|
| DO
NOT GIVE THROMBOLYTICS TO COOL-IT PATIENTS. |
|
| COOL-IT without STEMI (arrival to ICU) | Time Completed |
|
Repeat 12-lead ECG every 15 minutes if COOL-IT without STEMI. |
|
Transfer Check List:
(Check to confirm what has been sent with the patient.)
___ All copies of pre-hospital cardiac arrest rhythm strips
___ All ECGs
___ Lab results
___ CXR confirmation of ET tube verification
___ This form completed with timing of meds documented
___ Core temperature readings
___ Transferring provider H&P
IF THE PATIENT’S CONDITION CHANGES, CALL REFERRAL HOSPITAL AND ASK TO SPEAK WITH THE CARDIOLOGIST.
ROUTINE ORDERS: THERAPEUTIC HYPOTHERMIA AFTER CARDIAC ARREST
Date: __________Time of arrest: ____________ ED arrival time:
_____________________
Allergies:
__________________________________________________________________
INCLUSION
CRITERIA
A. Non traumatic cardiac arrest
B. Cardiac arrest < 60 min. from collapse to ROSC
C. Unresponsive S/P arrest; no response to verbal commands
D. For pediatric patients, consult with cardiologist.
EXCLUSION
CRITERIA
A. Comatose or vegetative state before arrest
B. DNR/DNI
C. Active bleeding
D. SBP <90 for > 30 minutes after ROSC despite the use of
vasopressors
STABILIZATION
___ Obtain 12-lead ECG to evaluate for Level 1 STEMI
___ Initiate transfer
___ Cardiac monitor
___ Intubate patient with 2 large-bore IVs in place
___ Remove all clothing (gown only). Avoid sheets and blankets.
___ Apply ice packs to the neck, axilla, and groin.
___ Attach hands-free defibrillation pads and obtain labs
___ Document cooling measures and record core temp every 10 minutes
___ Place NG tube if able, sedate with Ativan and Versed
___ Use paralytics as needed to prevent shivering
___ Check ETT placement per facility routine
COOL-IT/LEVEL I
STEMI MEDICATION PROTOCOL (arrival at CV lab):
___ Aspirin 30 mg rectally
___ Heparin loading dose of 60 units/kg (max 4000 units IVP)
___ Heparin continuous infusion at 12 units/kg/hr (max 1000 units/hour)
___ Plavix 600 mg per NG tube, if placement verified per abdominal
x-ray. (Do not delay transfer to referral hospital.)
___ DO NOT GIVE THROMBOLYTICS TO COOL-IT PATIENT.
COOL-IT WITHOUT
STEMI (arrival at ICU):
___ Repeat 12-lead ECG every 15 minutes if COOL-IT without STEMI
TRANSFER CHECK
LIST:
(Check to confirm what has been sent with the patient.)
| ___ All copies of pre-hospital cardiac arrest rhythm strips |
___ Core temperature readings |
| ___
All ECGs |
___
Completed data sheet with timing of meds documented |
| ___ Lab Results | |
| ___ CXR confirmation of ET tube verification | ___ Transferring physician H&P |
| ___________________________________________ | __________________________________________ |
| Physician Signature | Date |