Mild Therapeutic Hypothermia javier benitez (@jvrbntz) In 5 slides or less...
Case Presentation● 46 yo woman w PMH of HTN p/w witnessed OHCA one hour ago, she has ROSC after shocked when in VF rhythm, but has no return of consciousness. Bystanders state she was complaining of chest pain.● Vital signs are within normal limits. PE is normal wtih no signs of trauma.● She is sedated and intubated, IV access, ECG does not show signs of ischemia, trops, glucose, electrolytes, other labs, and CXR are normal
Things to Consider● Whats the goal temperature in therapeutic hypothermia?● List the phases of therapeutic hypothermia● What are the mechanisms by which therapeutic hypothermia exerts neuroprotection?
● The temperature goal is around 32o-34o C● Phases of therapeutic hypothermia – Induction: onset, rate, and target temperature – Maintenance: duration and temperature control – Rewarming: different approaches, but slow rate● Neuroprotection: – Decreases brain metabolism – Slows down cell death – Reduction of free radical production – Decrease inflammatory response – Protects the blood brain barrier
ReferenceTherapeutic Hypothermia After Cardiac Arrest in Adults:Mechanism of Neuroprotection, Phases of Hypothermia, andMethods of CoolingYinlun Weng, MD, Shijie Sun, MDCritical Care Clinics; Vol 28; issue 2; (April 2012) p.231-43