By Janice Petrella Lynch, RN, MSN
Monday April 18, 2011
Trinitas Hospital in Elizabeth, N.J., is prepared to treat patients who have had a cardiac arrest and who are eligible for therapeutic hypothermia. Twelve patients have been treated with TH since early January, and the hospital is the 16th in the state prepared to use the American Heart Association-approved resuscitation protocol. Patients who receive TH are unconscious and cooled to 33 to 34 degrees Celsius for 24 hours post resuscitation to preserve neurological functioning. Cooling implementation includes ice bags, cold IV fluids, surface cooling pads, analgesia and sedation, and monitoring of temperature and all other vital signs.
The Trinitas treatment protocol, called Code Frosty, was implemented Jan. 3, and the first patient to receive TH arrived in the ED that same day. “Code Frosty is an interdisciplinary effort, so throughout the month of December we held extensive training of our staff from nursing, cardiology, cath lab, ICU, ED, respiratory and pharmacy,” said Mary Beth Adams-Toms, RN, MAS, CEN, education department educator. All ICU and ED staff nurses and medical residents participated in the training program. “We used a PowerPoint presentation and YouTube videos to show how the experts were providing this care, and our staff helped us tweak the processes when they saw barriers or potential pitfalls that we could avoid,” said Debbie Durand, RN, APN, CCRN, clinical nurse specialist, critical care.
Patient Care
A patient who has had a cardiac arrest and has a return of spontaneous circulation within 60 minutes of the start of effective cardiopulmonary resuscitation is eligible for TH, provided he or she does not fit into any of the exclusion criteria. The patient usually arrives through the ED and may go to the ICU; the cath lab, for primary angioplasty; or the X-ray department, for a CT scan, depending on what the patient’s condition requires. “Trinitas has its own paramedic team, and when the ED is notified by the paramedics, the Code Frosty beeper system notifies the interdisciplinary team so everyone is ready,” said Cheryl Meyer, RN, CEN, nurse manager, ED. “The paramedics start the patient on an IV bolus of iced normal saline and ice packs before the patient arrives.”
Before Jan. 3, Trinitas established ED and ICU standard orders for patients who need and meet the requirements for TH. Inclusion and exclusion criteria are listed, along with initial management and cooling implementation. Pharmacy orders include drugs of choice for analgesia/sedation, shivering protocol and PRN orders during the 24-hour protocol, and deep vein thrombosis and gastrointestinal prophylaxis. “After attending a number of conferences on TH, we met with experienced individuals from Morristown Memorial Hospital and incorporated the University of Pennsylvania Center for Resuscitation Science information and guidelines during the process of establishing our training program and treatment protocols,” Adams-Toms said.
Cooling Implementation Protocol
Cooling implementation protocols include the following interventions: • Ice bags: Apply to neck, axilla and groin, and replace as needed; remove when goal temperature is reached
• IV fluids: Infuse 4 degrees C normal saline as needed; do not infuse into jugular or subclavian lines
• Temperature probe: Insert and record temperature every hour
• Surface cooling pads: Apply pads and set to automatic mode to goal temperature of 33 degrees C
• Vital signs: Take vitals every 15 minutes for the first hour, and then every hour
• Analgesia and sedation: Start analgesia and sedation on initiation of cooling
There are specific ED pharmacy orders at Trinitas that include medications for analgesia/sedation, shivering protocol, PRN orders during cooling period, DVT prophylaxis and an opthalmic lubricant. advertisement -------------------------------------------------------------------------------- Janice Petrella Lynch, RN, MSN, is a regional reporter. Send letters to editorNJ@nursingspectrum.com or comment below
