DO NOT USE UNAPPROVED ABBREVIATIONS
PATIENT IDENTIFICATION LABEL
ELIZABETH, NJ
AUTHORIZATION IS HEREBY GIVEN TO DISPENSE THE GENERIC OR
APPROVED THERAPEUTIC EQUIVALENT UNLESS OTEHRWISE
SPECIFIED.
THERAPEUTIC HYPOTHERMIA AFTER CARDIAC ARREST: ICU ORDERS
PAGE 1
DATE:
_______________
 PHONE ORDER  ORDER READ BACK AND VERIFIED WITH
 VERBAL ORDER
ORDERING PHYSICIAN FOR T.O./V.O.
MD NAME:________________/ _____________ R.N.
TIME:
_______________
ORDERED
1. Maintenance/ICU Phase:
 Surface cooling pads with cooling device set to automatic mode with goal temperature of 33°C.
 Goal temperature is 33°C for 24 hours from initiation of cooling protocol.
 Maintain goal temperature until:________________________________
 BMP, Magnesium, Calcium, Phosphorus, lactate, CBC, PT, PTT and ABG when goal temp is reached and every 6
hours until normo-thermic.
 CKMB, Troponin, Ck, q8h x 2.
 Initiate sliding scale insulin coverage if indicated.
 Titrate IV fluids to CVP 8-12 based on volume, cardiac status and clinical parameters
 Replace electrolytes as needed every 6 hours. See pharmacy PRN orders:
 NPO for 48h except medications through OGT.
 Follow routine ICU monitoring including BIS monitor every hour.
 Consider forehead sensor for Oxygen saturation reading.
 Monitor for shivering and document Bedside Shivering Assessment Scale (BSAS) every hour. Medicate as
necessary.
 Monitor skin condition; reposition every 2 hours.
 If the patient awakens and follows commands at any time, DISCONTINUE the Hypothermia Protocol and allow the
patient to passively warm.
2. Pharmacy Orders:
IV fluids:
 30ml/kg bolus of 4°C NS over 30 minutes STAT. Patient weight:________kg X 30ml=______________ml
 Give ____________________ml 4°C NS over 30 minutes STAT.
Analgesia/Sedation:
 Fentanyl 50mcg bolus followed by Fentanyl 500mcg/100mL D5W at 50mcg/hr. titrate to pain scale ≤3
 Propofol (Diprivan ®) 1000mg/100mL at 5 mcg/kg/min. Titrate to BIS score 40-60
 Lorazepam (Ativan®) 20mg/100mL D5W at 2mg/hr. Titrate to BIS score 40-60
Shivering protocol during cooling period (24 hours):
 Acetaminophen (Tylenol®) 650mg oral solution every 6 hours via OGT.
 Magnesium sulfate 2gm/50mL Sterile Water over 1hour
THEN
 Meperidine (Demerol®) 50mg IV Push (slowly over 10 minutes) every 1 hour PRN shivering for 2 doses.
THEN
 If above measures are ineffective, Vecuronium 0.1mg/kg IVP (diluted) over 1 to 2 minutes (Bolus x 1 dose)
 Start Vecuronium 100mg/100mL D5W IV infusion at 1mcg/kg/min. Titrate infusion to Train of Four (TOF) monitoring
once continuous infusion started. Titrate drug to maintain 1 to 2 twitches with TOF monitoring.
PRN orders during cooling period (24 hours):
 KCl 10meq/100mL IVPB every 6 hours PRN for Potassium <3.4mmol/L
 Magnesium sulfate 2gm/50mLSterile Water IVPB every 6 hours PRN for Magnesium <1.8mg/dL
 Calcium Chloride 1gm IV push every 6 hours PRN for serum Calcium <6mg/dL
DO NOT USE UNAPPROVED ABBREVIATIONS
PATIENT IDENTIFICATION LABEL
ELIZABETH, NJ
AUTHORIZATION IS HEREBY GIVEN TO DISPENSE THE GENERIC OR
APPROVED THERAPEUTIC EQUIVALENT UNLESS OTEHRWISE
SPECIFIED.
THERAPEUTIC HYPOTHERMIA AFTER CARDIAC ARREST: ICU ORDERS
PAGE 2
DATE:
_______________
 PHONE ORDER  ORDER READ BACK AND VERIFIED WITH
 VERBAL ORDER
ORDERING PHYSICIAN FOR T.O./V.O.
MD NAME:________________/ _____________ R.N.
TIME:
_______________
ORDERED
DVT prophylaxis:
 Patient is HIGH risk for bleeding.
 Venodyne boots to bilateral lower extremities.
 Heparin 5000 units subcutaneously □ every 8 hours
□ every 12 hours
 Enoxaparin (Lovenox®) 40mg subcutaneously Daily
 Enoxaparin (Lovenox ®) 30mg subcutaneously Daily (renal impairment dose)
 Enoxaparin (Lovenox®) 30mg subcutaneously every 12 hours.
GI Prophylaxis:
 Famotidine (Pepcid ® ) 20mg IV push every 12 hours
 Pantoprazole (Protonix ®) 40mg IV Push daily
Opthalmic lubricant:
 Lanolin/Mineral Oil/Petrolatum ophthalmic (Lacrilube®) apply to each eye every 6 hours
3. Rewarming Phase:
 At 24 hours, begin re-warming to 36.5°C over 12 hours (0.3°C/hr) using the surface cooling device at moderate
setting.
 Keep temperature at 36.5 to 37°C with cooling device for next 24 hours.
 Continue sedation at current rate until normo-thermic; then titrate off as tolerated
 Discontinue vecuronium infusion, if still infusing.
 Monitor and record vital signs and temperature every 15-30 minutes until normo-thermic.
4. Other orders:
Unit Secretary/RN:
_____________________________________ Date&Time:___________________
PHYSICIAN SIGNATURE________________________________
DATE/TIME: ____________________________
ORDER NOTED BY:
_____________________________________ Date&Time:___________________
RN’s Full Signature
Revised 1/4/11
USE BALL POINT PEN ONLY