THERAPEUTIC HYPOTHERMIA PROTOCOL RN TIPS
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Therapeutic Hypothermia Protocol Order Sheet is located on Dr. Kallus’s website
(www.kallus.com/er/) or in FirstNet go to links and click on ED Website. Remember this is only
a guideline for the MD – it is not an actual order set. The MD has to then enter EVERYTHING
into FirstNet. There is no order set in FirstNet for hypothermia at this time.
o All medications must be signed off in the EMAR
The Hypothermia Flow sheet is located in DAS. This is where you should be documenting your
VS, neuro checks, skin assessment, temp, etc. GOAL TEMP IS 32’ -34’C
FYI:
o Cold (4’C) crystalloid infusion can rapidly induce hypothermia at rates about 2.5’C/h to
3.5’C/h
o Two cooling blankets can cool at a rates of 1.0’C/h to 1.5’C/h and as high as 1.5’C/h to
2.0’C/h for hydrogel-coated water-circulating pads
o Ice packs can cool at a moderate rate of 0.9’C/h to 1.’C/h
If the MD orders NG tube lavage:
o Check for NG tube placement.
o Draw up ice cold water into irrigating syringe and gently instill or remove syringe
plunger, pour ice cold water into syringe barrel, and allow water to flow in by gravity.
Total amount will equal 250ml. This is every 15-30 minutes until target temperature is
reached.
o NG tube should be placed back to suction source between lavages to remove volume.
o Maintain strict I&O (volume instilled in should equal about volume that is then
suctioned out).
If the MD orders bladder lavage:
o Lavaging with ice cold saline, volumes of 200ml every 15-30 minutes
o Maintain the sterility of the saline and use a sterile irrigant container to pour saline in
each time.
o Maintain strict I&O. Document volume irrigated into bladder and volume returned.
Should be at least equal.
Watch your Blood Sugars HOURLY!!
o Since these patients can’t shiver (absent or controlled pharmacologically) – tend to be
hyperglycemic.
Eliminate Shivering:
o Shivering increases metabolic rate, heat production, and increasing oxygen
consumption. It will be a significant barrier to reach target temperature!
o Take warm blankets and wrap hands and feet
o If warm blankets do not stop shivering then sedatives and paralytics will be needed.
o Remember all medications must be ordered in FirstNet!
DST 11/10