Hypothermia - Cardiac Arrest Flashcards
Hypothermia - Cardiac Arrest - Definition
Vital signs absent in the presence of environmental factors promoting heat loss and other causes of absent vital signs have been excluded
Goal of Care
Prevent further cooling - rapid transport to a medical facility w/ active rewarming capability
Guiding Principles - part 1
Cardiac electrical activity should be assessed as soon as is feasible. If a monitor shows that organized rhythm is present, pulses should be carefully assessed.
For hypothermic patients without a pulse start CPR.
Cardiac arrest is possible below 32°C, and the risk increases substantially below 28°C. For patients with a core temperature >32 the cause of the arrest is not hypothermia. For patients in VF, CPR and up to 3 doses of epinephrine and defibrillation with further dosing guided by clinical response. If unsuccessful, do not pause CPR to analyze the rhythm until the core temperature has increased by at least 2-4°C. The pharmacokinetics of advanced cardiac life support medications are unpredictable in this group of patients. If unsuccessful, continue CPR and transport, concentrating on preventing further cooling and re-warming if possible.
Guiding Principles - part 2
Immersion CA victims in cold water with their head above water would likely be hypothermic CA
While a victim found with face in water (submersed) would be a drowning CA.
A person known to have submersed with a known onset time, and rapidly lost signs of life is a drowning.
Buried avalanche victims could be in CA from hypothermia, trauma or anoxia. Time buried, evidence of major trauma, and absence of snow packed airway are all factors to be considered.
Guiding Principles - part 3
The literature and available science on cold water immersion and drowning does not provide clear evidence to delineate a specific time frame for resuscitation. 60 minutes is a good guideline to use, taking into account the issues notes above and situations listed below. It is important to know that other agencies may have medical policy derived for best practise in their environment that differs from that used by BC emergency medical services. When working with Canadian Coast Guard on a call, mutual expertise regarding the environment and patient presentation along with consultation with the Rescue Specialist and/or CliniCall will guide good decision making.
If contact cannot be made with the receiving hospital AND transport time is greater than 60 minutes
- the following guidelines should be followed Procedures for cardiac arrest can be withheld in the field if:
- Chest is frozen/non-compliant.
- Victim has been completely submersed in water more than 1 hour.
- Obvious lethal injury is present (see guidelines for withholding resuscitation in traumatic arrest).
- CPR puts rescuers at risk.
- Avalanche victim found with no air pocket, or an airway packed with snow, or buried for >35 minutes
Special Circumstanc
With respect to hypothermia the pediatric population are a special cohort, particularly the very young.
These children have a relative large surface area to volume and are especially venerable hypothermia and cold water immersion.
Any child who is the victim of an ice water immersion event (i.e. there is ice on the surface of the body of water) who is in arrest should be considered potentially survivable and every effort to resuscitate should be undertaken.
Consult Clinicall if uncertain
Intervention Guidelines - EMR/PCP
Remove pt from environment
- prevent further cooling
- initiate warming where feasible
- thoroughly assess pulse resps - 30-45s
- VSA - CPR
- O2
- Transport
Intervention Guidelines - ACP
All above
Early transport to an ECMO capable facility
- Consider Lucas device if avail
Monitor - if organized electrical activity is noted review for presence of vital signs
VF
- CPR
- Defib x 1 only
- EPI x 1 only
PEA - Asystole
- CPR
- EPI x 1 only
Consult EP
Further Care
Active core rewarming
Warmed humidified O2
Cardiopulmonary bypass/ECMO
Management of electrolye and haematological abnormalities, tx of cardiac dysrhythmias
