2.50
Hdl Handle:
http://hdl.handle.net/10755/162409
Type:
Presentation
Title:
Nurse Driven Induced Hypothermia in the Pediatric Emergency Department
Abstract:
Nurse Driven Induced Hypothermia in the Pediatric Emergency Department
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Straub, Gretchen, RN
P.I. Institution Name:WakeMed Health & Hospitals
Title:Staff RN
Contact Address:3000 New Bern Avenue, Raleigh, NC, 27610, USA
Contact Telephone:919-350-2889
Co-Authors:Patricia Curtin, RN, CPEN; Eric AndrewReyer, RN, MSN, ACNP,CEN, CCRN
[ENA Annual Conference - Evidence-based Practice Presentation]

Purpose: This medical system's purpose of initiating induced hypothermia in the pediatric emergency department is to improve neurological outcomes in pediatric patients who initially survive cardiac arrest.

Design: Using evidence from the success of adult cardiac arrest patients treated with induced hypothermia and recommendations from the American Heart Association/Pediatric Advanced Life Support, this facility has developed a nurse driven protocol for induced hypothermia in patient age 37 weeks gestation to 14 years who initially survive cardiac arrest.

Setting: The pediatric emergency department which sees over 44,000 patients annually operates independently with 22 individual rooms and a dedicated staff who are trained in pediatric emergency medicine.

Participants: The inclusion criteria are patients greater than 37 weeks gestation through age 14, non-traumatic cause of arrest, and GCS <8. Exclusion criteria are trauma, uncontrolled bleeding, intracranial hemorrhage, uncontrolled arrhythmias, refractory hypotension, pregnancy, major surgeries, or sepsis.

Methods: Initially a literature review was completed. The nurse driven protocol and order set was developed in conjunction with RN and MD involvement. Education then took place to establish competency with more senior staff. Based on literature review and experience with adult patients at this facility, initiation of the cooling process should take place without delay. Therefore it is essential that the process begin in the ED.
Currently patients are cooled via iced saline and either an intravascular device or external cooling blankets depending upon size of the child. This process is initiated in the ED once a criterion is established by the physician.

Results/Outcomes: Outcomes have been promising with no neurological damage in more than 60% of pediatric arrest patients. Induced hypothermia has clearly shown to improve outcomes of pediatric clients who have presented with a pulse after cardiac arrest at this facility.
A case study will be presented on a 9 year old who arrived in his mother's arms with a prolonged down time and an initial rhythm of asystole. Immediate PALS protocols were initiated and return of spontaneous circulation was obtained. Induced hypothermia was immediately initiated in the pediatric emergency department. Several days after the protocol was completed, the boy was walking the inpatient halls without initial neurological deficits.

Implications: Induced hypothermia after cardiac arrest should not just be limited to just adult patients. It should be initiated in the emergency department as soon as inclusion criteria can be established or met and aggressively managed through a nurse based protocol.

Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleNurse Driven Induced Hypothermia in the Pediatric Emergency Departmenten_GB
dc.identifier.urihttp://hdl.handle.net/10755/162409-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Nurse Driven Induced Hypothermia in the Pediatric Emergency Department</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Straub, Gretchen, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">WakeMed Health &amp; Hospitals</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Staff RN</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">3000 New Bern Avenue, Raleigh, NC, 27610, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">919-350-2889</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">gretchen1969@nc.rr.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Patricia Curtin, RN, CPEN; Eric AndrewReyer, RN, MSN, ACNP,CEN, CCRN</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Evidence-based Practice Presentation] <br/><br/>Purpose: This medical system's purpose of initiating induced hypothermia in the pediatric emergency department is to improve neurological outcomes in pediatric patients who initially survive cardiac arrest. <br/><br/>Design: Using evidence from the success of adult cardiac arrest patients treated with induced hypothermia and recommendations from the American Heart Association/Pediatric Advanced Life Support, this facility has developed a nurse driven protocol for induced hypothermia in patient age 37 weeks gestation to 14 years who initially survive cardiac arrest.<br/><br/>Setting: The pediatric emergency department which sees over 44,000 patients annually operates independently with 22 individual rooms and a dedicated staff who are trained in pediatric emergency medicine. <br/><br/>Participants: The inclusion criteria are patients greater than 37 weeks gestation through age 14, non-traumatic cause of arrest, and GCS &lt;8. Exclusion criteria are trauma, uncontrolled bleeding, intracranial hemorrhage, uncontrolled arrhythmias, refractory hypotension, pregnancy, major surgeries, or sepsis. <br/> <br/>Methods: Initially a literature review was completed. The nurse driven protocol and order set was developed in conjunction with RN and MD involvement. Education then took place to establish competency with more senior staff. Based on literature review and experience with adult patients at this facility, initiation of the cooling process should take place without delay. Therefore it is essential that the process begin in the ED.<br/>Currently patients are cooled via iced saline and either an intravascular device or external cooling blankets depending upon size of the child. This process is initiated in the ED once a criterion is established by the physician. <br/><br/>Results/Outcomes: Outcomes have been promising with no neurological damage in more than 60% of pediatric arrest patients. Induced hypothermia has clearly shown to improve outcomes of pediatric clients who have presented with a pulse after cardiac arrest at this facility. <br/>A case study will be presented on a 9 year old who arrived in his mother's arms with a prolonged down time and an initial rhythm of asystole. Immediate PALS protocols were initiated and return of spontaneous circulation was obtained. Induced hypothermia was immediately initiated in the pediatric emergency department. Several days after the protocol was completed, the boy was walking the inpatient halls without initial neurological deficits. <br/><br/>Implications: Induced hypothermia after cardiac arrest should not just be limited to just adult patients. It should be initiated in the emergency department as soon as inclusion criteria can be established or met and aggressively managed through a nurse based protocol. <br/><br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:44Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:44Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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