By Arvind Venkat

With turning out to be numbers of chronically in poor health sufferers surviving longer and receiving novel clinical and surgical remedies, emergency departments are more and more the venue for linked acute displays. How can emergency physicians reply to those hard and rising stipulations? This ebook specializes in the weird and complicated sickness shows no longer coated intimately within the usual textbooks, aiding you Read more...

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Intensive Care Med 2007; 33(12): 2093–2100. 80. Nielsen N, Hovdenes J, Nilsson F, et al. Outcome, timing, and adverse events in therapeutic hypothermia after out-of-hospital cardiac arrest. Acta Anaesthesiol Scand 2009; 53(7): 926–934. 81. Gaieski DF, Band RA, Abella BS, et al. Early goal-directed hemodynamic optimization combined with therapeutic hypothermia in comatose survivors of out-of-hospital cardiac arrest. Resuscitation 2009; 80(4): 418–424. 82. Kampmeyer M, Callaway C. Method of cold saline storage for prehospital induced hypothermia.

Additionally, a cooling blanket can be placed to help lower core temperature. Initial experience with surface cooling showed it to be slow—needing between 4 and 6 hours to reach goal temperature [24,25,75]. More advanced protocols have added neuromuscular blockade and sedation to minimize motion and shivering and have successfully cooled most patients below 34◦ C within 4 hours [71]. The only preparations to use surface cooling are having a source of ice and a readily available cooling blanket.

Overall, initiation of post-cardiac arrest care in the ED is straightforward when done in an algorithmic fashion. Focusing on airway (A), pulmonary function (B), systemic and brain perfusion (C), neuroresuscitation (D), and appropriate disposition in a stepwise approach makes the induction of this therapy more practical in a busy ED. However, a typical patient requires and deserves 1 hour or more of critical care time while still in the ED with potential for more depending on the procedures performed.

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