This research paper discusses post resuscitation Hypothermia use in Emergency medical services. Post therapeutic hypothermia improves the patient’s health outcomes by lowering the risks of injuring the tissues. The therapy increases the mortality of the cardiac arrest survivors. The therapy maintains a therapeutic hypothermia for 24 hours at a target temperature of 330 C, and it increases the survival chances. The therapy prevents brain damage by reducing the demand of oxygen in the brain. The main methods used in conducting the therapy using cooling blankets, ice water lavage, cooling helmets, ice packs, and cooling catheters. The diseases that require the therapy include Spinal cord injury, Cardiac arrest, traumatic brain injury, ischemic stroke and neonatal encephalopathy. The post-resuscitation hypothermia has affects blood sugar levels, the cardiovascular system, the respiratory rates, metabolic rates, gastrointestinal system, Renal functions, Hematologic system and the Neurologic functions. The patient’s central body temperature is monitored via either the bladder or the esophagus.
This research paper discusses post resuscitation Hypothermia use in Emergency medical services. Post therapeutic hypothermia is a form of active treatment which helps in achieving and maintaining a specified body temperature in a patient for a specific duration in a bid to improve the patient's health outcomes. Post therapeutic hypothermia is useful in emergency situations because it lowers the risks of injuring the tissues due to lack of blood flow. The scenarios of low blood flow may be due to blockage of arteries or cardiac arrest. The inducement of mild therapeutic hypothermia in some specific cardiac arrest patients that are surviving out of the hospital improves the rates of the survival. Accordingly, post-resuscitation hypothermia is one of the greatest advancement in clinical medicine. Post Resuscitation Hypothermia improves the neurological outcomes and the mortality of the cardiac arrest survivors. The therapy aims at achieving and maintaining a therapeutic hypothermia for one day with a target temperature of 330 C. The management of the target temperature increases the survival chances and improves the functioning of the brain after resuscitation following a cardiac arrest. Consequently, the post Resuscitation Hypothermia prevents brain damage by reducing the demand of oxygen in the brain, lowering the rate at which neurotransmitters such as glutamate are produced and reducing the free radicals that may damage the brain. The main methods of reducing the body temperature include using of cooling blankets, ice water lavage, cooling helmets, ice packs, and cooling catheters.
2.0 Post Resuscitation Hypothermia Protocols
The greatest and highest neurological benefit can be attained if the TH (Therapeutic Hypothermia) is induced at the earliest chance. The cardiac arrest patients ought to be cooled to a temperature of between 32 0C and 340 C for the duration of 12 hours and 24 hours. There should be continuous and accurate monitoring of the core temperature using either esophageal thermometry or the bladder. Normally, there is unintentional overcooling alongside hypothermia towards the end of the active cooling (Castren et al., 2009).
TH is very critical in the provision of supportive post-resuscitation care to the cardiac patients. Post resuscitation should optimize metabolism, hemodynamic and oxygenation. It is not easy to predict neurological outcomes using clinical evaluations that follow 24-48 hours of the post-arrest. Therefore, there should be an early treatment of the cardiac arrest patient, and the prognostication should be put on hold until the patient has rewarmed, and the impact of sedation has been minimized. The procedure of post-resuscitation acre is made up of three steps namely Induction stage, maintenance stage, and the rewarming stage (Gold et al., 2014).
3.0 Medical use of Post Resuscitation Hypothermia care
Post Resuscitation Hypothermia care is used in emergency situations for patients with the following diseases: Spinal cord injury, Cardiac arrest, traumatic brain injury, ischemic stroke and neonatal encephalopathy.
3.1 Cardiac arrest
American Heart Association (AHA) offers guidelines that guide Post Resuscitation Hypothermia care. AHA recommends that the cardiac arrest patients should be cooled to a temperature of 320 c after a cardiac arrest in a bid to improve the survival and functioning of the brain (Yannopoulos et al., 2009).
Currently, there are no complete trails on the impact of Guide Post Resuscitation Hypothermia care on stroke patients. However, the studies have been conducted on animals, and they indicate that it is effective in reducing the clotting threshold in animals (Peberdy et al., 2010).
3.3 Traumatic brain or spinal cord injury
Studies conducted on animals indicate that Post Resuscitation Hypothermia care has a significant impact in cases of traumatic CNS (Central nervous system) injuries. Further satisfies the need to be conducted to ascertain the efficiency of the therapy (Yannopoulos et al., 2009).
3.4 Neonatal encephalopathy
Post Hypothermia therapy in the neonatal case encephalopathy has improved the outcomes for the newborn kids suffering from prenatal hypoxia-ischemia. The therapy reduces the mortality rates and cerebral palsy in the newborns (Peberdy et al., 2010).
4.0 Adverse effects
The possible side effects that are associated with the therapy include high blood sugar, infection, dysrhythmias, and bleeding. In other cases, it increases the risks of sepsis and pneumonia. Cardiovascular effects include Ventricular arrhythmias, myocardial depression, Increased SVR and increased QT intervals. Respiratory effects include decreased RR, increased secretions, oxyhemoglobin shift and decreased a cough. Metabolic effects include low drug biotransformation, low tissue perfusion, and reduced metabolic rate. Gastrointestinal effects include decreased motility, stress ulceration, insulin increase. Renal effects include decreased ADH, decreased urine output and decreased renal plasma flow. Hematologic effects include harm concentration and Platelet dysfunction. Neurologic effects include decreased muscular tone, confusion, decreased LOC, coma and decreased reflexes (Grasner et al., 2011).
The Post Resuscitation Hypothermia care mechanism aims at reducing the cellular metabolism by reducing the body temperature. Every drop in the body temperature slows the metabolisms rate by approximately 6%. Accordingly, the mechanism decreases the body’s requirement for oxygen, and this reduces those harmful effects that come with ischemia. The decline in the body temperature promotes the stability of the cell membrane that is essential in cases when the cell is deprived of oxygen. Accordingly, the reduction of the body temperature prevents the increase of the ions that are unwanted because they result from an ischemic insult. Post Resuscitation Hypothermia care increases the permeability of the cell membrane, and this prevents the reactions that are associated with oxygen deprivation. Further, the therapy reduces reperfusion injury that occurs during oxidative stress. Accordingly, the mechanism lowers the production of free radicals and the intracranial pressure (Castren et al., 2009).
6.0 Methods of Post Resuscitation Hypothermia care
The main methods of conducting the post-resuscitation hypothermia include cooling catheters, application of ice and cooling blankets. The patient’s central body temperature is measured through either the bladder or the esophagus. Temperatures below 30 °C are not recommended because they increase adverse event in the patients’ body. The patient should take pharmacological agents before the target temperature is induced to prevent shivering. Examples of the anti-shivering drugs include desflurane and pethidine.
6.1 Cooling catheters
The cooling catheters are normally placed in the femoral vein and then a cooled saline solution circulates through a tube that is placed in the catheter. The saline solution cools the patients by reducing the temperature at a rate of 2 °C per hour. However, there are adverse events that may occur due to the use of the catheters, and they include deep vein thrombosis, bleeding, vascular puncture and infection (Castren et al., 2009).
6.2 Trans nasal evaporative cooling
The trans nasal evaporative method induces hypothermia by providing means of cooling a patient continuously during the initial stage of managing the target temperature. The method uses a canola that is inserted into the patient’s nasal cavity, and it delivers a spray of the coolant mist that goes to the base of the skull. When the blood goes through the cooling region, it lowers body temperature in the whole body Grasner et al., 2011).
6.3 Water blankets
There are technologies that allow water to circulate through blankets, leg wraps and torso wrap around vests. 70% of the patient’s body surface is normally covered by the water blankets and as such the body temperature is controlled. However, the water blankets may allow leaking and other electrical hazards (Yannopoulos et al., 2009).
6.4 Cool caps
The non-invasive cold caps facilitate cooling in the brain, and the hypothermia caps are usually made from neoprene, polyurethane, and silicone. The caps have a cooling agent that can be either gel or ice normally frozen to a temperature of between −25 to −30 °C (Peberdy et al., 2010).
In conclusion, this research paper has discussed post resuscitation Hypothermia use in Emergency medical services. Post therapeutic hypothermia helps in maintaining a specified body temperature in a patient. The cardiac arrest patients ought to be cooled to a temperature of between 32 0C and 340 C for the duration of 12 hours and 24 hours. Post Resuscitation Hypothermia care is used in the following emergency situations: Spinal cord injury, Cardiac arrest, traumatic brain injury, ischemic stroke and neonatal encephalopathy. The therapy has effects on blood sugar the Cardiovascular the respiratory system, metabolic system, gastrointestinal system, renal system, Hematologic system and the Neurologic system. The mechanism used in the therapy reduces the cellular metabolism by reducing the body temperature. The main methods of conducting the therapy include cooling catheters, application of ice and cooling blankets. The patient's central body temperature is measured through either the bladder or the esophagus.
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