Tag: hypothermia

Aug 21 2019: NIV, nitrous, bradycardia, hypothermia, neck dissection, AF

Ventilator troubleshooting and Nitrous sedation
– I have attached the charts and procedures the nurse educators were using and they are also posted here:
 
 
HOUR of POWER
Bradycardia and hypothermia (Adi)
1) consider the big 4 causes of resistant bradycardia
– toxins, ischaemia, potassium, hypothermia
2) have a step-wise approach to bradycardia
– treat reversible causes
– trial of atropine
– chemical pacing: isoprenaline or adrenaline
– electrical pacing
3) hypothermia
– there are passive and active rewarming techniques
– modifications to usual resuscitation include:
– gentle handling if T < 32 (risk of VF is present but necessary procedures are necessary)
– adrenaline where T < 30 probably not useful
– in arrest where T = 30-35 deg double the time interval between doses of adrenaline (ie every 8 min)
Carotid and vertebral artery dissections (Keira)
– these types of dissections are rare, but potentially devastating
– remember to be thorough and specific with your neuro exam and try to “spot the difference” with every new case to every previous case of muscular neck pain you see
– when patients represent – think about changing something – “where else” do we need to go with this case?
Journal club – delayed v early cardioversion in AF (Yasmin)
– another study suggesting that rhythm control is not as important as rate control

enFlow fluid warmer

Both Footscray and Sunshine campuses currently use the enFlow fluid warmer. It is relatively easy to set-up and can quickly heat fluids (blood/crystalloid) to 40 degrees celsius.

Indications:

  1. hypothermia – active warming
  2. massive transfusion – prevention of coagulopathy

Contraindications:

  1. hyperthermia

Device set-up (manufacturer video – 3min)

Key points

  1. warmer cartridges are single patient use only
  2. the cartridge can be considered an extension of the drip line and hence must be primed to avoid air embolism
  3. note the helpful arrow on the cartridge to indicate direction of flow
  4. extension tubing can be added to the cartridge for difficult ergonomic situations but will carry a risk of heat loss distal to the warmer.

The warmer is found in the resus storeroom at Footscray, and the warmer cartridge and arm-pad near the bottom left of the shelves on the back wall.

warmer cartridge storeroom