Wednesday, August 22, 2012

Management of VF arrest

Passive rewarming

  • Temperature is very important during rewarming as temperature commonly overshoots normal. Warming the patient too quickly or allowing continued shivering causes dangerous electrolyte shifts, leading to potentially lethal arrhythmias
  • Controlled rewarming of 0.15° to 0.5° C per hour is recommended. 
  • To maintain tight temperature control throughout rewarming a neuromuscular blockade is usually employed.  
  • Careful fluid monitoring during rewarming is crucial because of the vasodilation that accompanies a body temperature rise. Volume replacement may be needed to prevent fluid deficit and hypotension.
  • Electrolytes shift out of the cells back into the serum during rewarming, so frequent electrolyte monitoring is needed during this phase to prevent critically elevated levels. Slow, controlled rewarming allows the kidneys to excrete excess potassium, preventing hyperkalemia
  • Hypoglycemia can occur during rewarming as the insulin resistance of earlier hypothermia phases diminishes. Glucose levels must be monitored frequently, with insulin titration and dextrose boluses used as needed to maintain the patient within ordered ranges.

References

  • http://www.americannursetoday.com/article.aspx?id=8014&fid=7986
  • http://ccforum.com/content/16/S2/A25/ 

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