Problem:
Goal:
Therapeutic Hypothermia
Prevent Shivering
Interventions
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Goal:
Observe for shivering during active cooling and maintenance period every hour
and document shivering assessment scale
Apply warm blanket to feet and hands only to help decrease shivering
Administer ordered narcotic, sedation and/or neuromuscular blockade as
needed
Obtain baseline “Train of Four” then monitor every hour if NMB required
Maintain vital signs within normal range
Interventions
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Goal:
Monitor temperature, heart rate and rhythm, respiratory rate, blood pressure,
oxygen saturation, central venous pressure, pulmonary pressures and cardiac
output and index (if pulmonary artery catheter present) and end tidal CO2
Document patient temperature setting on internal device and water
temperature on external device q1hr.
Vital signs every 60 minutes or as indicated until therapy completed
Administer ordered vasopressors as needed to maintain mean arterial blood
pressure greater than 65 mmHg
Monitor blood pressure via arterial line
Monitor and document intake and output every hour – observe for increased
diuresis
Continuous cardiac monitoring – observe for ischemic and/or prolonged QT
intervals
GCS (Glasgow Coma Scale) every 4hrs.
Maintain normal range lab values
Interventions
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Observe for hypokalemia during active cooling
Observe for hyperkalemia during rewarming
Observe for decreased platelet and neutrofil count
Observe for prolonged PTT and/or PT/INR
Observe for decreased magnesium and/or phosphate levels
Monitor RBG every six hours on subq Insulin coverage during cooling
Monitor RBG every 2hrs during rewarming on subq insulin
Monitor RBG every hour if on IV Insulin infusion
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Goal:
No RBG obtained from finger stick
All blood samples to be obtained from arterial or central venous line
Lab value schedule as per Therapeutic Hypothermia order bundle
Temperature corrected ABG q6hr during maintenance phase and q2hrs during
rewarming
Achieve target temperature of 33°C within 4-6 hours of return of spontaneous
circulation
Interventions
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Goal:
External cooling via Cincinnati Sub Zero Hypothermia console and Kool Kit Body
Wrap
Endovascular cooling via Thermogard XP machine and Alsius internal venous
catheter
Maintain target temperature for 24 hours after target obtained
Do not use warm humidification on the vent during therapeutic hypothermia
If target temp not reached within 4hours notify MD and add ice packs to groin
and axilla and consider bolus of cold NSS (cooled to 4ºC) over 10mins.
Complete rewarming safely
Interventions
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Goal:
Begin rewarming 24 hours after target temperature achieved
Rewarm over 10-12 hours at rate of 0.25°C per hour to target temperature of
36°-37°C
Observe for ventricular dysrhythmias
Discontinue neuromuscular blockade when temperature is > 36°C
Maintain Alsius catheter and connection to Thermogard XP machine for 24
hours after rewarming completed
Observe for upward temperature drift after rewarming
If drift occurs, restart cooling to maintain temperature of 36°-37°C
Maintain goal body temperature
Interventions
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Monitor body temperature by two sources
Do not use tympanic or axillary temperatures
Insert temp probe foley catheter
Insert rectal probe with external cooling
Monitor core temperature via pulmonary artery or Alsius catheter