Download Sudden Cardiac Arrest

Eat, Sleep and Breathe
Therapeutic Hypothermia
after Cardiac Arrest
Sanford Neurocritical Care
Patient Education
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To family members of a loved one with a traumatic brain injury,
My son had a brain hemorrhage and was in the Critical Care for over 3 weeks. It was an
extremely stressful time and I want to give you some tips on how to get through this.
Take care of yourself; you will be pulled in many different ways. You may have many visitors. They all care and
want to help you. You will feel like you need be present with them. Be kind and visit with them in the waiting
room. They may all want to go into your loved one’s hospital room. Your friends and family may want updates
on the progress or lack of progress that your loved one is making in the Critical Care. You have told the story
over and over in person and on the phone, and have spent countless hours visiting in the waiting room. You have
tried to sleep but your mind goes wild when you close your eyes. Sleep is difficult to achieve. Everyone wants to
know how to help and all you want is for your loved one and your life back to normal. It may be exhausting.
Ways that friends and family can help: (it is okay to give them direction; as they will feel great they can do something!)
Bring Kleenex with lotion (your nose will be grateful!)
Set up a Caring Bridge site at www.Caringbridge.org. This site will be one spot where you can tell
your story and update it electronically. Family and friends can access it and send you messages. This
really is a great way to save your energy so you can focus on what your loved one needs.
Take breaks away from the hospital. Even a short walk outside will help. An occasional good
night’s sleep in your own bed will help you cope and get through the days.
Hand or body lotion with lavender scent, as this helps with relaxation.
Bring water or your favorite non-alcoholic drink to you. My friends took turns bringing me a Starbucks every
morning. We had a quick visit (~15 minutes, which is perfect) and I could get ready to hear the physician
and team rounds. Do not be afraid to ask questions. There is no such thing as a dumb question.
Choose one of your friends or family to be the “contact person” for you. This person should be someone
emotionally strong and well organized. Use this person to be the primary first contact for friends and
relatives to touch base with about meals needed, brief status updates and visiting preferences.
To organize meals at noon or the evening, if you are staying in the waiting room. It is okay to give them your likes
and dislikes. I suggested just enough for 3-4, no desserts and that we eat lots of salads, fruits and vegetables.
A friend of ours brought us a collection of current magazines – travel, sports,
food and women’s interest, which helped us look at something.
We asked all of our visitors to check in with us first before entering the room. Lots of noise and constant stimulation
by others does not provide a restful environment that is needed in the Critical Care. I wanted to be the one to talk
and see responses from my son and didn’t want him exhausted and have problems with high intracranial pressure.
I allowed family and friends to peek in at him, I coached them to be quiet, no talking in the room, minimal
touching (only if his ICP/CPP were in the parameters), and they washed their hands to prevent infection.
The hospital chapel is a peaceful environment for prayer or solitude.
Keep a journal of your thoughts, hopes and fears. Your loved one will want to know this
information after they recover. It will help this time seem real to them also.
Be patient, loving and kind with others. Never give up on HOPE.
Sincerely,
Carol
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Table of Contents
Neurocritical Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Identify a Family Spokesperson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Sudden Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Risk Factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Tests Your Doctor May Include . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Medical Personnel Description List. . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Induced Hypothermia “Cooling”. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Critical Care Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Critical Care Equipment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Brain Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Organ, Eye & Tissue Donation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
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Neurocritical Care
Advice for Families and Loved Ones
Families of former patients developed these coping tips. This information is meant to give you
practical steps you can use to help yourself and your loved ones through this crisis.
• Encourage the immediate family to see your injured family member if they desire.
• Obtain a notebook. Write down questions regarding your loved one’s condition as they come to your mind, you
can then ask the physician the questions and note the answers so that you can share with other family members.
• Keep your children and/or immediate family well informed, do not try to
“protect” anyone. You will need the support of the entire family.
• Assign a family contact person to take calls, provide updates, etc.
• Seek out support from friends, ministry, church, head injury support
groups, nurses, social workers, chaplains or doctors.
• Assign a family member to file and organize medical statements, insurance information, rehab information, etc.
• When you are ready, take pictures of your injured loved one, you will appreciate
these pictures later; the Critical Care staff may be able to assist you.
• Let friends and associates help by providing food, transporting visitors and assisting with children.
• Leave an ongoing message on your voice mail at home with updates as to the condition
of your loved one or enroll in an online journal such as Caring Bridge.
• Take a walk with friends, loved ones, allow yourself to get out.
Identify a family Spokesperson
It can become very overwhelming as you contact family members with the condition of their loved one.
When relaying medical information, it is often helpful to select a family member to be in charge of getting
this information to others. This person is known as a family spokesperson. It’s vitally important that the
whole family knows that they are to seek and relay information through the family spokesperson.
What Does a Family Spokesperson Do?
The family spokesperson acts as a link between the entire family and the health care staff. The role of this
person is to contact all of the friends and relatives who need to be updated with the patient’s condition.
Why Do We Need a Family Spokesperson?
To protect patient privacy, information is often restricted to the family spokesperson. Having
a family spokesperson also eliminates frequent calls to Critical Care. Frequent calls repeatedly
draw the staff away the patient, often to answer the same question for various people.
How Do We Identify a Family Spokesperson?
This person should be someone who listens well, speaks well and tends to remain calm in a crisis.
This person is seldom the most immediate relation to the patient, such as the spouse.
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Sudden Cardiac Arrest
Definition
Sudden cardiac arrest is the sudden, unexpected loss of heart function, breathing and
consciousness. Sudden cardiac arrest usually results from an electrical disturbance in your
heart that disrupts its pumping action, stopping blood flow to the rest of your body.
Sudden cardiac arrest is different from a heart attack, which occurs when blood flow to a portion of the heart is
blocked. However, a heart attack can sometimes trigger an electrical disturbance that leads to sudden cardiac arrest.
Sudden cardiac arrest is a medical emergency. If not treated immediately, it causes sudden cardiac death. With
fast, appropriate medical care, survival is possible. Administering cardiopulmonary resuscitation (CPR) — or
even just compressions to the chest — can improve the chances of survival until emergency personnel arrive.
Symptoms:
• Sudden cardiac arrest symptoms are immediate and drastic.
• Sudden collapse
• No pulse
• No breathing
• Loss of consciousness
• Sometimes other signs and symptoms precede sudden cardiac arrest. These may include
fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, weakness, palpitations
or vomiting. But sudden cardiac arrest often occurs with no warning.
Causes:
The immediate cause of sudden cardiac arrest is usually an abnormality in your heart
rhythm (arrhythmia), the result of a problem with your heart’s electrical system.
Unlike other muscles in your body, which rely on nerve connections to receive the electrical stimulation
they need to function, your heart has its own electrical stimulator — a specialized group of cells
called the sinus node located in the upper right chamber (right atrium) of your heart. The sinus node
generates electrical impulses that flow in an orderly manner through your heart to synchronize the
heart rate and coordinate the pumping of blood from your heart to the rest of your body.
If something goes wrong with the sinus node or the flow of electric impulses through your heart,
an arrhythmia can result, causing your heart to beat too fast, too slow or in an irregular fashion.
Often these interruptions in rhythm are momentary and harmless. But some types of arrhythmia
can be serious and lead to a sudden stop in heart function (sudden cardiac arrest).
The most common cause of cardiac arrest is an arrhythmia called ventricular fibrillation — when rapid,
erratic electrical impulses cause your ventricles to quiver uselessly instead of pumping blood.
Most of the time, cardiac-arrest-inducing arrhythmias don’t occur on their own. In a person with a normal, healthy
heart, a lasting irregular heart rhythm isn’t likely to develop without an outside trigger, such as an electrical shock,
the use of illegal drugs or trauma to the chest at just the wrong time of the heart’s cycle (commotio cordis).
Heart conditions that can lead to sudden cardiac arrest
A life-threatening arrhythmia usually develops in a person with a pre-existing heart condition, such as:
Coronary artery disease
Most cases of sudden cardiac arrest occur in people who have coronary artery disease. In coronary
artery disease, your arteries become clogged with cholesterol and other deposits, reducing blood flow
to your heart. This can make it harder for your heart to conduct electrical impulses smoothly.
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Heart attack
If a heart attack occurs, often as a result of severe coronary artery disease, it can trigger ventricular
fibrillation and sudden cardiac arrest. In addition, a heart attack can leave behind areas of scar tissue.
Electrical short circuits around the scar tissue can lead to abnormalities in your heart rhythm.
Enlarged heart (cardiomyopathy)
This occurs primarily when your heart’s muscular walls stretch and enlarge or thicken. In both cases, your
heart’s muscle is abnormal, a condition that often leads to heart tissue damage and potential arrhythmias.
Valvular heart disease
Leaking or narrowing of your heart valves can lead to stretching or thickening of your heart
muscle or both. When the chambers become enlarged or weakened because of stress caused
by a tight or leaking valve, there’s an increased risk of developing arrhythmia.
Congenital heart disease
When sudden cardiac arrest occurs in children or adolescents, it may be due to a heart condition
that was present at birth (congenital heart disease). Even adults who’ve had corrective surgery
for a congenital heart defect still have a higher risk of sudden cardiac arrest.
Electrical problems in the heart
In some people, the problem is in the heart’s electrical system itself instead of a problem
with the heart muscle or valves. These are called primary heart rhythm abnormalities
and include conditions such as Brugada’s syndrome and long QT syndrome.
Risk factors
Because sudden cardiac arrest is so often linked with coronary artery disease, the same factors that put you
at risk of coronary artery disease may also put you at risk of sudden cardiac arrest. These include:
• A family history of coronary artery disease
• Smoking
• High blood pressure
• High blood cholesterol
• Obesity
• Diabetes
• A sedentary lifestyle
• Drinking too much alcohol (more than one to two drinks a day)
Other factors that may increase your risk of sudden cardiac arrest include:
• A previous episode of cardiac arrest or a family history of cardiac arrest
• A previous heart attack
• A personal or family history of other forms of heart disease, such as heart rhythm
disorders, congenital heart defects, heart failure and cardiomyopathy
• Age — the incidence of sudden cardiac arrest increases with age, especially after age 45 for men and age 55 for women
• Being male — men are two to three times more likely to experience sudden cardiac arrest
• Using illegal drugs, such as cocaine or amphetamines
• Nutritional imbalance, such as low potassium or magnesium levels
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Tests your doctor may recommend include:
Electrocardiogram
A test commonly given after cardiac arrest is an electrocardiogram (ECG). During an ECG, sensors (electrodes) that can
detect the electrical activity of your heart are attached to your chest and sometimes to your limbs. An ECG measures
the timing and duration of each electrical phase in your heartbeat and can reveal disturbances in heart rhythm. Because
injured heart muscle doesn’t conduct electrical impulses normally, the ECG may show that a heart attack has occurred. An
ECG can detect abnormal electrical patterns, such as a prolonged QT interval, that increase your risk of sudden death.
Blood tests:
Cardiac enzyme test.
Certain heart enzymes leak into your blood if your heart has been damaged by a heart attack. Because a heart
attack can trigger sudden cardiac arrest, it’s important to know whether you’ve had a heart attack. Testing
a blood sample for these enzymes may help indicate whether a heart attack has indeed occurred.
Electrolyte test.
A sample of your blood may also be tested for levels of electrolytes, such as potassium, calcium and magnesium.
Electrolytes are minerals in your blood and body fluids that help create electrical impulses. An imbalance
in the levels of these substances can increase your risk of arrhythmia and sudden cardiac arrest.
Drug test.
Your doctor may check your blood for evidence of drugs that have the potential to induce
arrhythmia, including certain prescription and over-the-counter drugs and illegal drugs.
Hormone test.
Testing for hyperthyroidism may indicate this condition as the trigger for your cardiac arrest.
Imaging tests may include:
Chest X-ray.
An X-ray image of your chest allows your doctor to check the size and shape of your heart
and its blood vessels. It may also indicate whether you have heart failure.
Echocardiogram.
This test uses sound waves to produce an image of your heart. An echocardiogram can help identify
whether an area of your heart has been damaged by a heart attack and isn’t pumping normally
or at peak capacity (ejection fraction) or whether there are valvular abnormalities.
Ejection fraction testing.
One of the most important predictors of your risk of sudden cardiac arrest is how well your heart is able to pump blood.
Your doctor can determine your heart’s pumping capacity by measuring what’s called the ejection fraction. This refers
to the percentage of blood that’s pumped out of a filled ventricle with each heartbeat. A normal ejection fraction is 50
to 70 percent. An ejection fraction of less than 40 percent increases your risk of sudden cardiac arrest. Your doctor can
measure ejection fraction in several ways: echocardiogram, magnetic resonance imaging (MRI), a nuclear medicine
scan (multiple gated acquisition, or MUGA), a computerized tomography (CT) scan or a cardiac catheterization.
Nuclear scan
This test, usually done along with a stress test, helps identify blood flow problems to your heart.
Tiny amounts of radioactive material, such as thallium, are injected into your bloodstream. Special
cameras can detect the radioactive material as it flows through your heart and lungs.
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Coronary catheterization (angiogram)
This test can show if your coronary arteries are narrowed or blocked. Along with ejection fraction, the
number of obstructed blood vessels is another important predictor of sudden cardiac arrest.
Treatments and drugs:
Sudden cardiac arrest requires immediate action for survival.
CPR
Immediate cardiopulmonary resuscitation (CPR) is critical to treating sudden cardiac
arrest. By maintaining a flow of oxygen-rich blood to the body’s vital organs.
Defibrillation
Advanced care for ventricular fibrillation, a type of arrhythmia that can cause sudden cardiac arrest, typically
includes delivery of an electrical shock through the chest wall to the heart. The procedure, called defibrillation,
momentarily stops the heart and the chaotic rhythm. This often allows the normal heart rhythm to resume.
Drugs
Doctors use various anti-arrhythmic drugs for emergency or long-term treatment of arrhythmias or
potential arrhythmia complications. A class of medications called beta blockers is commonly used in
people at risk of sudden cardiac arrest. Other possible drugs include angiotensin-converting enzyme
(ACE) inhibitors, calcium channel blockers or a drug called amiodarone (Cordarone).
Implantable cardioverter-defibrillator (ICD)
After your condition stabilizes, your doctor is likely to recommend implantation of an
ICD. An ICD is a battery-powered unit that’s implanted near your left collarbone. One or
more electrode-tipped wires from the ICD run through veins to your heart.
Coronary angioplasty
This procedure opens blocked coronary arteries, letting blood flow more freely to your heart, which may
reduce your risk of serious arrhythmia.Coronary angioplasty may be done at the same time as a coronary
catheterization (angiogram), a procedure that doctors do first to locate narrowed arteries to the heart.
Coronary bypass surgery
Another procedure to improve blood flow is coronary bypass surgery. Bypass surgery
involves sewing veins or arteries in place at a site beyond a blocked or narrowed coronary
artery (bypassing the narrowed section), restoring blood flow to your heart.
Corrective heart surgery
If you have a congenital heart deformity, a faulty valve or diseased heart muscle tissue due to cardiomyopathy, surgery
to correct the abnormality may improve your heart rate and blood flow, reducing your risk of fatal arrhythmias.
Heart transplantation
Some people with severe heart failure who’ve experienced cardiac arrest may be eligible for
a heart transplant. But given the lack of donor hearts, availability is limited.
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Medical Personnel Description List
There are many medical professionals who provide the high level care needed for a patient in Critical
Care. This team works together to coordinate and deliver the best care possible for your loved one.
Intensivist
Physician who specializes in caring for the critically ill or injured patient.
Neuro intensivist
Physician that has been specially trained in caring for the critical care patient with a brain injury.
Some patients will also require consulting physicians such as an orthopedist (a physician who
specializes in the bones), an endocrinologist (a physician specializing in blood sugar management,
or a physiatrist (a physician who specializes in rehabilitation medicine), etc.
Registered nurse (RN)
Provides direct care to the patient including giving medications, monitoring vital signs and equipment.
The nurse provides treatment for patients as determined by clinical guidelines. They discuss patient
changes with the doctors and coordinate all the tests and treatments. Nurses in the Critical Care Unit
care for 1 to 2 patients depending on the condition of the patient. The RN has the most up to date
information regarding your loved one’s condition and is a great source of information for you.
Advanced Practice Provider
Provider who has special training in treatment and management of the injured brain and spine.
They follow the patient while they are in the hospital to ensure continuity of care. APPs are
great resource to explain the injury and treatment your loved one is receiving.
Respiratory Therapists
Provide specialized care to support the breathing needs of the patient. They manage the patient’s airway,
and monitor oxygen and other respiratory needs. They assist the physician in managing the ventilator.
Occupational, speech, and physical therapists:
Provide care that will help the patient maintain and improve their ability to use their muscles and prepare them
for more intense rehabilitation. They also assist with daily activities like eating, sitting, and walking.
Case managers
Provide continuity of care while your loved one is hospitalized. They provide ongoing support and
education for patients and families and are available to assist in looking into care needs after the patient is
discharged from the hospital. In addition to the above caregivers, there is other support staff available
to help patients and families during their hospital stay.
Social Workers
The social worker is available to provide supportive counseling to patients and families. Social workers also
assist families with accessing community resources, support groups and financial and housing needs.
Spiritual Care
We care about your emotional and spiritual wellbeing while you are here and have chaplains available
24/7 to support you. They offer care to all people while respecting culture, beliefs, and traditions.
You may request a visit with a chaplain at any time by asking your nurse to contact a
chaplain or by dialing “0” and the Operator will locate a chaplain for you.
The nurse caring for your loved one can contact any of the above people to support you during this difficult time.
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Induced Hypothermia “Cooling”
What is a Cardiac Arrest?
When a person stops breathing and their heart stops beating, this is called a “cardiac arrest.” It is a
medical emergency. The longer a person’s heart has stopped, the lower their chance of survival.
What is “Induced Hypothermia?”
Induced Hypothermia is a medical treatment that lowers a patient’s body temperature in order to help reduce
the risk of the ischemic injury to tissue following a period of insufficient blood flow after cardiac arrest.
“Hypothermia” means having a low body temperature. “Induced hypothermia” means that the healthcare
team lowers the body temperature, on purpose, to help your family member survive their cardiac arrest.
Induced Hypothermia “Cooling”:
• Involves cooling a patient to a core temperature of 32°C to 34°C within 8 hours of the cardiac arrest.
• The patient will remain cooled for an extended period of time – usually about 24 hours.
• It can only be performed in a Critical Care setting by a specially trained medical team.
• The medical team provides continuous monitoring to obtain the best possible outcome for your family member.
How does induced hypothermia help your loved one?
Hypothermia lowers the body’s need for oxygen and energy. As a result, there is
more oxygen available in the blood for the body, and vital organs.
Induced hypothermia has been proven to decrease brain damage if started as soon as possible after a cardiac arrest.
What should I expect?
• Your family member will be wrapped in a mechanical cooling blanket or a catheter placed
intravascular, that changes the level of cooling based on the patient’s core temperature.
• Your family member will be given medication to sleep and to keep them as comfortable as possible.
• A ventilator (breathing machine) will help them to breathe.
• Intravenous (IV) medications will be given through a large IV line.
• EEG that will monitor brain activity.
• They will be monitored at the bedside and at the nursing stations.
The doctor will talk to you (and your family member when possible) about further treatment and care options. You
will be able to have all your questions answered. Any plans for the care of your loved one will be made together
with you, take into account the patient’s previously expressed wishes, if any, and his or her best interests.
What are the risks of Induced hypothermia?
1. H
ypothermia may make the patient more prone to infection. This is because when the body
is cool, the immune response (our body’s “defense” system) is lowered. The healthcare
team will do everything possible to prevent infections from happening.
2. It may make some patients more prone to bleeding. We will watch your family member closely for any signs of this.
Keep in mind that evidence shows that the benefits of induced hypothermia, in many patients, outweigh the potential risks.
If at any time during the cooling process the risk to the patient should outweigh
the benefits, the doctor will stop the cooling process.
What should I expect after the cooling therapy is done?
Cooling is done by guidelines. Within the first 24 hours your family member will be cooled to 33° F degrees . When
the time comes for them to be re-warmed, it occurs at a very slow rate. The time to re-warm is very case dependant.
If you have any questions about induced hypothermia, please talk to your doctor or bedside nurse.
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Critical Care Procedures
Angiogram
An angiogram is an x-ray test that allows the radiologist (a physician who specializes in x-ray interpretation)
to study blood vessels. The physician injects contrast dye into the patient’s blood vessels, so that they
may be seen on x-ray. This exam helps the physician in making a diagnosis and treatment plan.
The patient will be transported to the Radiology Department A needle with a small catheter will be inserted into an
artery in the groin through which dye can be given. X-rays of the artery will be taken to look for spasm or abnormality.
Bronchoscopy
Bronchoscopy is a procedure which allows the physician to view the air passages of the lungs. It
may be used to collect specimens, clear secretions, find and remove foreign objects in the lungs,
or biopsy a mass in the lungs. The main reason for the use of a bronchoscope in Critical Care is
for patients whose breathing passages have become clogged with mucous or secretions.
The bronchoscope (a flexible tube with a powerful light and lens) is inserted through the mouth, nose, endotracheal
tube or tracheostomy into the trachea. The bronchoscope light source and flexible tip allows the physician to explore
the air passages. The bronchoscope is attached to suction that allows the removal secretions or foreign objects.
Computerized Axial Tomography Scan (CT Scan)
CT scanning, sometimes know as CAT scanning, combines special x-ray equipment with sophisticated computers to
produce multiple images or pictures of the inside of the body. These cross-sectional images of the area being studied can
then be examined on a computer monitor. A CT scan can show bleeding, swelling, and a change of body structures.
Craniectomy
The medical team’s focus is to keep the brain pressure low. Medications, drainage of the cerebrospinal fluid (CSF)
from the tube inside the brain, and changes to ventilator settings are all techniques used to reduce brain pressure.
Sometimes the intracranial pressure (ICP) will continue to rise above normal and require more aggressive procedures.
The neurosurgeon may determine that a craniectomy (removal of part of the skull) is necessary to control brain pressure.
The patient must go to the operating room for this procedure. In the operating room, the neurosurgeon
will open the scalp and cut an opening in the bones of the skull on one or both sides. The neurosurgeon will
remove a portion of the bone. The skin is then closed over the brain. The bone is stored for replacement in
the head at a later date when the brain swelling has decreased and the patient has had time to recover.
Magnetic Reasonance Imaging
Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave
energy to make pictures of organs and structures inside the body. In many cases, MRI may show
problems that cannot be seen with other imaging methods such as xray or CT scan.
For an MRI test, the area of the body being studied is placed inside a special machine that contains a strong
magnet. In some cases, contrast material may be used during the MRI scan to show certain structures more
clearly. MRI can look at the brain for damage as a result of traumatic brain injury, tumors, aneurysms,
bleeding in the brain, nerve injury, and other problems, such as damage caused by a stroke.
Tracheostomy
If it is necessary for the patient to remain on the ventilator for an extended time, the physician may recommend a
tracheostomy. This procedure will increase patient comfort and allow ventilatory support and secretion management.
A temporary surgical opening is made at the front of the throat providing access to the trachea/ windpipe to assist in
breathing. A plastic tube is inserted and connected to the ventilator. When appropriate, the patient will be placed on
a ventilator weaning protocol. At later dates, the trach can also be managed to allow the patient to eat and speak.
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Transcranial Doppler Ultrasonography
Transcranial Doppler Ultrasonography (TCD) testing uses sound waves to measure the speed at which
blood flows through the large blood vessels in the head. The procedure is done with probes placed against
the skin. The examiner uses a clear gel on the areas of the head where the probe will be placed.
Combined with other tests, this test can be used to find blockages of the blood vessels in the brain, and
find changes in blood flow. TCD’s may be done daily for several days for patients with traumatic brain
injury. This test allows the physician to know the progress and resolution of vasospasm.
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Critical Care Equipment
Breathing tube
Portable X-ray Machine
Ventilator
EEG Machine
Oxygen Probe
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Nutrition
Tube Feedings
Corpak/Feeding Tube
Nasogastric Tube
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Percutaneous Endoscopic Gastrostomy PEG Tube
Specific Brain Monitoring
Licox (Brain Oxygenation and Temperature)
Therapeutic Hypothermia Cooling Machines
Camino (ICP)
Intravascular Cooling Catheter
Ventriculostomy Drain
Pupillometer
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Lines
Central Line
Arterial Line
Peripherally Inserted Central Catheter (PICC)
IV Pole
Peripheral IV Site
16 Therapeutic Hypothermia After Cardiac Arrest
Brain Death
1. What does it mean to be brain dead?
When a person is brain dead, the brain can no longer function. The doctors have done all they can to treat
the person’s condition. However, the brain will not recover function, and the person is considered dead.
The doctors can support the heart with medication. They can also provide oxygen through a ventilator, or
breathing machine. The person’s body can be supported for days and, sometimes, even weeks. However,
there is no reason to do so. A brain death diagnosis is final and cannot be reversed. The person will never
awaken. When a physician determines a person is brain dead, that is the time of his or her death.
2. What causes brain death?
Brain death results from a major injury to the entire brain. Often brain swelling has injured the brainstem,
which connects the brain to the body. This injury cannot be reversed. Brain death is often caused by traumatic
head injury. Other causes are brain hemorrhage (bleeding) and cardiac arrest followed by CPR.
3. How does brain death occur?
When the brain is injured, it responds in much the same way as an injury like a twisted ankle - it swells. Unlike the
muscle and tissue of the ankle, the brain is in a confined space – the skull – and has no room to swell. Head trauma,
bleeding in the brain from a stroke or aneurysm, or prolonged cardiac arrest that decreases brain oxygen will cause the
brain tissue to swell. The action of the brain swelling inside a closed space and the build-up of pressure is what can
ultimately lead to brain death. As the brain swells inside the skull, it pushes downward toward the brain stem blocking
all upward flow of blood. Depending on the type of injury, this may happen within minutes or over a period of days.
Even while the heart is still beating and supplying blood to the rest of the body, blood that carries oxygen cannot reach
the brain or the brain stem, which controls heart rate and breathing. The result is that the brain and the person dies.
4. Documenting Brain Death
Brain death is a clinical, measurable condition whose formal definition emerged after the President’s Commission
for the Study of Ethical Issues in Medicine embraced brain death in 1981. The electroencephalogram (EEG) of
someone who is brain dead shows no electrical activity, and an injection of mild radioactive isotopes into the brain
reveals the absolute absence of blood flow. People who are brain dead also have no gag response, their pupils do not
respond to light and they do not blink when a swab touches their eyeballs. They do not respond to pain, and in the
absence of signals from the brain, their lungs have stopped working—only the ventilator keeps them “breathing.”
5. There is No “Recovery”
Brain death can be confusing, particularly for families who are confronted with the sudden death of someone they
love, because a brain dead person on a ventilator can feel warm to the touch and can look “alive.” The heart is still
beating and the ventilator is pushing oxygen and air into the lungs making the person’s chest rise and fall. When
this happens, some families expect that the person they love can simply be kept on the ventilator in hopes that their
condition will improve. But to be brain dead is to be dead, and no improvement or recovery is possible. Defibrillators
used to “shock” a heart may get it functioning again within the first several minutes after it stops. But there is
no such method to jump-start or revive a brain that has been deprived of blood and whose cells have died.
Organ, Eye and Tissue Donation
Organ Donation after Brain Death or Circulatory Death
There are two types of organ donation. There is organ donation after brain death or organ donation after circulatory
death. The opportunity for organ donation is most often discussed after brain death or circulatory death is determined.
The patient remains in the Critical Care Unit on a ventilator to provide blood and oxygen to the body. During this time,
the hospital staff will perform medical tests to determine options for donation. There are also times when a family makes
a decision to withdraw medical support on behalf of their loved one who has suffered a devastating brain injury but is
not brain dead. Following this decision, families are given the opportunity to consider organ and tissue donation.
The gifts of organs, tissues, and corneas are possibilities when medical support is withdrawn.
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18 Therapeutic Hypothermia After Cardiac Arrest
Notes
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20 Therapeutic Hypothermia After Cardiac Arrest