Post Arrest Hypothermia

So, your cardiac arrest patient now has a pulse. Great work! Now what? The new AHA guidelines really stress post-resuscitative care. Induction of "therapeutic hypothermia" immediately after return of spontaneous circulation has been clinically proven to preserve brain function. This is due to the decreased metabolic demands on the brain in the hypothermic patient. The criteria for this is essentially any patient post arrest who is comatose, and not septic. The studies were done on post-arrest patients that had been in ventricular fibrillation, but patients with a history of PEA or asystole are also candidates for therapy. The goal is to induce low body temperature for the first 12-24 hours post-arrest. The goal temperature is 32-34 Celsius (about 90-93 Fahrenheit.) This can be accomplished with ice packs to the armpits and groin, but that takes a while. A faster way is to begin chilled saline boluses. Fridge temperature saline is fine. If given at around 100ml per minute IV, (via a pressure bag,) each 100ml is expected to drop body temperature around 1 degree Celsius every 10 minutes. A 500ml bolus may well be sufficient, as the average adult body temperature is 37 Celsius. So, rechecking a temperature in 30 minutes should reveal a temp of about 34 Celsius. To maintain this temp for 12-24 hours, automatic cooling blankets are best. They often are placed under and over the patient. These utilize a temperature probe (esophageal probe, or bladder probe) connected to the device to maintain the temperature of the patient within the desired range. There are medications that are also commonly used to assist in maintaining the temperature. A Fentanyl drip can be useful here, as it decreases the body's shivering response (shivering will raise temperature) as well as keeping the patient sedated. A non-sedated patient may have increased brain activity, which is counter- productive. Tylenol via suppository is also useful to blunt the body's hypothalamic (temperature control) response. The patient does not necessarily need to be paralyzed. Some would say don't paralyze the patient, as the non-sedated, or poorly sedated paralyzed patient will surely have increased brain activity which will not be recognized. Potential complications include coagulopathy- hypothermia can cause bleeding. Another problem is that hypothermia causes a decreased immune response, so it is not really indicated for septic patients. Frequent blood sugar checks are Again, the non-comatose patient who achieves return of spontaneous circulation is not a candidate for this therapy. Cessation of therapeutic hypothermia generally consists of ceasing cooling measures, and allowing the body temperature to come up naturally.

Improving our service!

We are always striving to improve our service. You may now purchase your online course externally, either through the AHA, or a third party vendor, like Laerdal (some health care agencies even offer the online portion internally, and refer out for the skills session!), and then simply sign up for a skills session when you have completed it!. We hope that this will allow our clients the flexibility to truly complete the online portion of the course in their time frame, not ours! from our Online Learning section "Simulation is the most useful tool in teaching. Simulation is research proven to help students retain. Additionally, self guided learning leads to the best retention rates. Online content means consistent quality, content, and delivery. This is why we wish to bring you this e-simulation technology. The best part is that these courses are done at YOUR pace. Please feel free to contact us with questions or to explore more traditional (classroom) course options. " Thank you for your continued support of our service!

EpiPen for severe allerrgic reactions

Someone having a severe allergic reaction with trouble breathing and/ or swelling of the airway may need help in using their epinephrine pen. An EpiPen is device often carried by people with a known history of these types of severe reactions. These reactions can be caused by anything from bee stings to peanut butter. EpiPens are designed to go through clothing, and should be injected into the outside part of the leg, halfway between the hip and knee. Heart Association recommends keeping the pen in place 10 seconds to allow the medication to auto inject into the patient, and to massage the area for a few seconds afterwards to promote blood flow. Be aware that EpiPens have a safety on the top of the injector that must be removed before use. Do not touch the orange bottom part of the injector. This is where the needle comes out. The needle is automatically shielded when removed from the leg, so that should not be a major worry, but it needs to be "inserted" into the leg firmly. Follow up after using an EpiPen should be 911, as the patient will need close monitoring for some time. Note the time that the EpiPen was used.

The Alpha and the Beta of Vasopressors

Alpha- primarily affects vessels

Beta- Primarily works on the heart ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Vasopressors are commonly talked of as having Alpha and Beta properties. What does this mean, and how to keep it straight? I like to remember Alpha properties by envisioning a blood vessel end-on. To me, it looks a lot like the big loop in the Greek symbol for Alpha. This is a good thing, because the Alpha properties of vasopressors primarily serve to constrict peripheral vessels, thereby "shunting" blood to the core organs, heart and brain (although they also tend to constrict micro-circulation there as well) and thereby increasing blood pressure. The Greek symbol Beta looks a heck of a lot like a stylized heart turned sideways, and the Beta properties of pressors generally work there as well, increasing heart rate (chronotropy) and force of contraction (inotropy). Pressors can work primarily in one way or the other, or both. Epinephrine has about equivalent properties for both Alpha and Beta. Dopamine is interesting, because at low doses it has primarily Beta properties, whereas at higher doses, the Alpha predominates. Another drug that we used to use in the ACLS algorithms, Isoproterenol, is basically all Beta.

Ticks Suck (Literally)!!

ahhh, summer time! Baseball, hikes, beer, ticks. Ticks in and of themselves don't really create a problem. They don't cause pain, only take a tiny amount of blood, then they leave. Problem is, ticks carry and transmit a fair amount of nasty dieases, like Lyme and Rocky Mountain Spotted Fever. These diseases can be a nightmare to diagnose and treat because they have a dizzying constellation of symptoms, including potential neurological complications, malaise, and fever. Best to avoid being bitten if possible, and do frequent tick checks. DEET is still the repellent of choice, placed at the cuffs of pants, long sleeved shirts, and even on hats. If a tick is found attached, the recommendation is removal right away with tweezers placed really close to the person's skin. Continued, even pressure applied straight up is the way to go. Experts do not recommend burning them off, or putting any lotions or petroleum jelly on them to loosen them first, as this can make them regurgitate into their host. Don't twist the tick out!. If any jaw parts are left in, these can be removed with a needle or by scraping. Ticks can be saved for identification, and possible testing if needed. Lyme disease, the biggest risk in the U.S. for "vector-borne" disease, (a disease transmitted to humans through an animal host) is an east coast disease primarily transmitted by very small deer ticks, and actually takes at least 24 hours of the tick being attached to transmit it to a human. Some say it takes 48 hours or more. Unfortunately, it does have a high prevalence due to the fact that the ticks are so small and hard to see, which means they can remain on longer undetected. Rocky Mountain Spotted Fever can be transmitted in just an hour or two. Don't be misled by the name, this disease is prevalent on the east coast as well.

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SIDS reduction

The first step in the AHA's Pediatric Chain of Survival is prevention and safety. With that in mind, and the fact that everyone I know is having a baby, let's talk a little about SIDS. Sudden Infant Death Syndrome is a fairly poorly understood mechanism of "crib death" usually seen in infants two to four months of age. Statistics show that there are many modifiable things that can be done to reduce SIDS death rates. Among them are: Placing the baby on the back to sleep. Not smoking during pregnancy, and keeping smoke out of the home. Keeping the environment cool. (In other words, don't let the baby get too warm). Minimize blankets and stuffed animals, (and anything else) in the crib to make sure the baby can't suffocate. Maintaining a good flow of fresh air in the room. Use a breathable, mesh type crib bumper. The research and thinking points to SIDS related deaths being caused by a few factors. Rooms with minimal air flow, or lots of blankets, heavy bumpers, and stuffed animals can create dead spaces, where the carbon dioxide can build up, ultimately causing respiratory failure due to the baby's own exhalations. A warm room also can contribute to this due to creating less of a buoyant quality on the exhaled air. Placing a fan in the room can help circulate air. (Of course, don't blow the air directly on the baby!) Other factors that may contribute to SIDS deaths are less clear, but the numbers point to actions that can reduce risk. Breastfeeding reduces SIDS deaths by up to 50%. . Keeping your baby in the room with you during this time (NOT in the same bed!) has been shown to reduce SIDS deaths. Baby sleeping with a pacifier may reduce SIDS. The recommendation is NOT to replace it if it falls out of the baby's mouth while sleeping. For some reason, children with up to date immunizations have a lower SIDS rate. This may be reflective also of up to date pediatrician visits. Congratulations to all of the new mothers out there, and here's to safe sleep and healthy kids!