mssmem.com

I forget…what did that email say? oh yeah, its at mssmem.com

A plea re: hypothermia

Folks,

I know this is beating a dead horse, but some of us are still cooling patients that are inappropriate and will not benefit from the therapy. The other day I walked in to a patient being hooked up to arctic sun pads that was 83 y/o, with dementia, and possible sepsis. We discontinued hypothermia, signed a FHCDA and got palliative care involved. The patient went up to the floor and was terminally extubated with all of the family present.

This case brings up the need to reiterate the following:

Please don’t cool patients with dementia or sig. cognitive decline.
Please don’t cool patients who can’t manage their ADLs independently
Please don’t cool patients with poor baseline status
Please don’t cool patients with a significant downtime unless they were found in v-fib/vtach
The default is not to cool patients >=80 y/o. I have left this as relative b/c if you have an 80y/o who looks 50 with none of the above, you may want to cool, but the DEFAULT is not to cool these patients
Each use of the arctic sun costs about $2000 in pads; in addition if the ICU continues cooling, the pt will be in the ICU for 5-7 days unnecessarily.

Now let’s say you just can’t handle making this decision. You can’t handle withholding care from ANYONE; it just isn’t in your practice pattern. You have some recourse:

Email Me; if I am around I will call you back immediately and I am happy to take the burden of withholding this therapy
If it is a borderline case, use ICED SALINE and the BLANKETROL machine instead of the arctic sun. If the ICU decides to continue, then they can switch over to arctic sun. If they don’t you have only wasted $100 instead of $2000
Please send me your thoughts and comments.

thanks,
Scott

Written by reuben

January 27th, 2012 at 9:10 pm

Posted in Elmhurst,Hypothermia

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