Page 94 - Critical Care Notes

4223_Tab02_045-106 29/08/14 10:00 AM Page 88

CV
■ Monitor for hypotension.
■ Rewarm slowly at 0.3° C–0.5° C/hr.
■ If no signs of neurological improvement 72 hr after rewarming and discon-
tinuation of neuromuscular blockers, determine brain death and seek full
neurological evaluation.
Management
■ Monitor BP. Arterial line is preferred.
■ Provide continuous ECG monitoring and monitor for sinus bradycardia, pro-
longed PR interval, widened QRS, prolonged QT interval, atrial fibrillation,
VT, and VF. Avoid atropine.
■ Consider pacemaker or AICD.
■ Monitor hemodynamics. Pulmonary artery catheter is preferred. IABP may
be indicated.
■ Administer vasopressors as needed.
■ Monitor for seizures.
■ Monitor fluids and electrolytes, especially K + and glucose levels. Induction
causes mild diuresis. Provide fluid replacement. Hyperglycemia can occur
during maintenance phase, and hypoglycemia can occur during rewarming.
■ Consider CRRT.
■ Prevent skin breakdown resulting from vasoconstriction from cold. Consider
prone position.
■ Ileus is common during hypothermia.
■ Hypothermia suppresses inflammatory response → infection. Hand hygiene
and infection control practices are imperative.
■ Assess for bleeding. For every 1°C drop in temperature, coagulation-factor
function ↓ by 10% and affects the coagulation cascade.
■ Obtain oral or axillary temperatures only or use temperature probe,
esophageal bladder, pulmonary artery catheter, or other methods.
■ Prevent shivering through the use of sedation and neuromuscular blockade.
Administer chlorpromazine (Thorazine) or diazepam (Valium).
■ Hypothermia ↓ body’s ability to respond to stimulation, making assessment
of sedation level difficult. Use bispectral index monitors or continuous EEG
monitoring.
■ Assessing level of neuromuscular blockade using train-of-four monitoring
not always reliable. Refer to Tab 1, Basics.
■ Hypothermia affects drug metabolism. Lower doses of drugs may be
needed.
■ Prepare patient for immediate coronary angiography and/or PCI.

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