Disseminating-Evidence Project - Essay Example

? Disseminating-Evidence Project Disseminating-Evidence Project Introduction Induced hypothermia otherwise referred to as therapeutic hypothermia, or protective hypothermia is essentially a medical treatment protocol, which entails lowering a patient’s body temperature so as to help deter the occurrence of ischemic injuries to tissues. Ischemic injuries occur as a result of the body experiencing periods of inadequate blood flow due to cardiac arrest or stroke due to occlusion of an artery from an embolism. Induced hypothermia can occur through invasive methods during which a medical practitioner inserts a catheter in the inferior vena cave through the femoral vein. Conversely, induced hypothermia can also occur through non-invasive means, typically involving the use of a chilled water blanket, leg wraps or torso vests placed in direct contact with the skin of the patient. Previously conducted studies indicate that patients with the potential risk for ischemic brain injuries have immense chances positive outcomes when treated with an induced hypothermia protocol (Binks et al. 2010). This paper will examine the medical protocol of induced hypothermia, discussing its inherent advantages on neurological outcomes. The paper will provide an account of induced hypothermia, describing the different protocols and effects of hypothermia on the human brain. The paper will culminate with a comprehensive dissemination plan that entails a roundtable discussion. Since its inception, induced hypothermia protocols have proved quite effective. Background Medical practitioners have applied hypothermia therapeutically since ancient times. The history of induced hypothermia dates as far back as the Hippocrates era although the first published medical article on induced hypothermia was in 1945. The world’s initial modern doctor i.e. Greek physician Hippocrates endorsed the packing of injured soldiers using ice and snow. Napoleonic surgeon Dominique Jean Larrey observed that officers kept near fire had lower survival chances than officers kept in cold environments. The study first published in 1945 focused on the impacts of hypothermia on patients affected by head injuries. In the mid 20th century, hypothermia obtained its initial medical application used in intracerbal aneurysm surgery with a view to establish a bloodless field. Notably, most of the initial research into induced hypothermia concentrated on the application of deep hypothermia i.e. applications of body temperatures between 20-25 °C. This extreme drop in body temperature produces an array of effects that made the application of deep hypothermia quite impractical. The 1950s also saw intense investigation of mild forms of induced hypothermia, i.e. 32-34 °C. During this period, Dr. Rosomoff exemplified in dogs the advantages of mild hypothermia pursuant to a traumatic brain injury or ischemia. Researchers conducted further animal studies in the 1980s showing the capacity of mild hypothermia to function as a general neuroprotectant, especially after obstruction of blood flow to the brain (Sessler, 2005). In 1999, after a skiing accident Anna Bagenholm’s heart stopped beating for at least three hours during which her body temperature was 13.7 °C prior to resuscitation. In addition to animal studies, as well as Anna Bagenholm’s misfortune, there have been at least two landmark studies published in 2002 in the New England Journal of Medicine. Both studies demonstrated the benefits of applying mild hypothermia following a cardiac arrest. Subsequently, in 2003, the International Liaison Committee on Resuscitation (ILOR) and the American Heart Association (AHA) endorsed the application of mild hypothermia after cardiac arrest. Presently, a growing number of hospitals worldwide incorporate the recommendations of AHA/ILCOR and embrace hypothermic protocols in their standard care packages for patients who suffer cardiac arrest. Certain researchers further contend that induced hypothermia is a better neuroprotectant after obstruction of blood the brain than any recognized drug (Sessler, 2005). In addition, there have been successful research efforts, which showed that induced hypothermia is extremely effective as a treatment applied to newborn infants after birth asphyxia. These studies show that induced hypothermia for approximately 72 hours started within six hours of birth substantially enhanced the chance of survival without the incident of brain damage. The positive effects of induced hypothermia emanate from the rationale that hypothermia slows cellular metabolism. This causes dramatic reductions in body temperature thereby reducing the body’s demand for oxygen. Drops in temperature enhance the stability of cell membranes during episodes of oxygen deprivation. A drop in body temperature, therefore, helps deter an influx of unwanted ions in the course of an ischemic insult. In essence, hypothermia deters the cascade of responses triggered by oxygen deprivation by making cell membranes impermeable. PICOT Questions The central or PICOT question of this examination is: In the adult population (population), how does induced hypothermia (intervention or issue) compare to non hypothermia interventions (comparison) preserve the vital organs (outcome) during the first 24 hours after insult?   Research Findings Today, the application of mild hypothermia is a routine element of early post-resuscitative support to survivors of comatose cardiac arrest. In randomized clinical trials, patients resuscitated through out-of-hospital ventricular fibrillation demonstrated notable improvements in both mortality and neurological outcomes. However, there have been incidents where patients remained unstable after the return of spontaneous circulation (ROSC) who presented with cardiogenic shock syndrome (CSS). Recently, there researchers have experienced positive outcomes with mild hypothermia in haemodynamically unstable survivors of cardiac arrest. This suggests that mild hypothermia is also beneficial in such cardiac arrest survivors. The incident of CSS pursuant to ROSC is not essentially a contraindication of the initiation of mild hypothermia. Essentially, the application of mild hypothermia in comatose survivors of cardiac arrest presenting with CSS pursuant to ROSC produces higher mortality rates than such application in relatively stable patients (Skulec et al. 2008). However, the severity of the initial injury as captured by a high score on the injury severity score (ISS) and a low mark on the Glasgow Coma Scale Score Post-Resuscitation (GCS-PR) is attributable to development of hypothermia in patients suffering from brain injuries. In a study conducted by Hilaire et al, (2010) it became clear that, when hypothermia is accompanied by quick rewarming, the hypothermic patients present with worse neurological outcomes, as well as higher mortality rates post injury, than when rewarming is not done rapidly. Rapid rewarming causes afterdrop, which ultimately emerges when warm blood shunts to the periphery while cold blood flows to the core as a result of vasodilation. Therefore, in order to deter this occurrence, it is paramount that physicians constantly monitor both the patient’s skin and core temperature such as rectal and bladder. Nonetheless, the researchers affirm finding from previous studies that therapeutic hypothermia is beneficial in brain injury, hypoxic postcardiac arrest, as well as neonatal hypoxic encephalopathy. This is because hypothermia reduces mortality and improves outcomes in the aforementioned incidents. Binks et al (2010) conducted a telephone survey to ascertain the popularity of induced hypothermia in UK ICUs noting that the popularity of induced hypothermia has increased dramatically since its introduction in ILCOR guidelines of 2003. This study served to exemplify the premise that ILCOR’s guidelines enhanced use of induced hypothermia in ICUs across the globe. Notably, cognitive dysfunction often occurs in survivors of out-of-hospital-cardiac-arrest despite a normal health related quality of life (HRQOL). Notably, OHCA patients present lower scores in terms of episodic memory and executive function than the normal population. Therefore, there is essentially no difference in alertness and response time or delayed memory. These findings agree with previously reported affection of patients’ temporal lobe, but do not address the issue of delayed memory or motor impairment. Executive dysfunction, as well as frontal lobe affection, is frequent in OHCA patients (Torgersen et al (2010). Disseminating Plan  The discussion will concentrate on the purpose of induced hypothermia in the enhancement of outcomes and mortality among cardiac arrest and stroke patients. What is the essence of considering induced hypothermia in the realization of positive patient outcomes? In the adult population (population), how does induced hypothermia (intervention or issue) compare to non hypothermia interventions (comparison) preserve the vital organs (outcome) during the first 24 hours after insult? The panel consists of an ER physician, Nurse Educator and a neurologist. Every participant will get seated around a roundtable and introduce him or herself to create a friendly environment in which participants share their thoughts. I will begin by asking the PICOT question of the study, exemplifying the need to discuss the relevance of induced hypothermia in the medical field. In order to bring participants’ attention to the issue at hand, I will hand out a PowerPoint presentation regarding induced hypothermia. The PowerPoint will encompass a strong argument for the utilization of induced hypothermia to enhance patient outcomes and deter mortality. After all participants are alert to the necessity of discourse regarding induced hypothermia, we will commence the discussion section with the discussion of the importance of developing a viable strategy. I will begin by stating the importance of establishing a viable strategy. This will ensure that every practitioner is versed with sufficient knowledge regarding the steps taken in the application of induced hypothermia. All medical practitioners must have knowledge of proper application of induced hypothermia because this knowledge could spell the difference between life and death. The ER physician with whom I have been coordinating my research will introduce the topic of induced hypothermia, discussing its applicability by reiterating the various studies conducted to ascertain the protocol’s effectiveness. I will forthwith ask anyone who experienced induced hypothermia to describe the experience and the consequences of such an experience. This will allow the participants to appreciate the intricacies of induced hypothermia while also dismissing their previous misconceptions towards the protocol. I will ask the nurse educator whether or not she has covered the topic in her lessons to nurses. If the nurse educator responds affirmatively, I will request her to give the participants a mock lesson on induced hypothermia and demonstrate using a mannequin the steps involved in the process of induced hypothermia. At this point, the participants will have a succinct idea of importance, as well as steps involved in induced hypothermia. This will provide a proper opportunity to in-depth discussions of the application of induced hypothermia to critically ill patients. All participants will share their views concerning the effectiveness of the protocol under various circumstances, for instance, in OHCA and neonatal patients. At this point, the neurologist will give her input on the effects of ice on neurotransmitters and the brain as a whole. This input will enhance participants’ understanding of the consequences of induced hypothermia on the body. I will then request the participants to ask any questions they may have about induced hypothermia. I will respond to the questions with the assistance of other participants. The last activity of the day will be a mock hypothermia induction to fortify the lessons of the day in the minds of all participants. The participants will share their final thoughts and discuss the steps involved in hypothermia induction. The meeting will end with a mutual appreciation for the importance of induced hypothermia. Conclusion Moderate temperature drops strengthen cellular membranes thereby minimizing distortions to the cellular environment. It is such moderation of homeostatic disruption caused by obstruction of blood flow, which enhances hypothermia’s capacity to reduce the trauma resultant from ischemic injuries (Sessler, 2005). An ER nurse’s experiences are quite pertinent to the survival of cardiac arrest and stroke patients since the nurses are versed with knowledge of proper hypothermia induction. ER nurses first encounter cardiac arrest and stroke patients before such patients receive additional medical attention. Therefore, ER nurses play a vital role in ensuring that such patients’ outcome are positive, and their mortality rates are low. References Binks, A. C., Murphy, R. E., Prout, R.E., Bhayani, S., Griffins, C. A., Mitchell, T., Padkin, A., & Nolan, J. P. (2010), Therapeautic hypothermia after cardiac arrest- implementation in UK intensive care units. Journal of the Association of Anaesthetists of Great Britain and Ireland, 65, 260-265. Sessler, D. (2005). "Thermoregulation and Heat Balance." In Therapeutic Hypothermia (Eds). Mayer, S. & Sessler, D. New York: Marcel Decker. Skulec, R., Kovarnik, T., Dostalova, G., Kolar, J., & Lunhart, A. (2008). Induction of mild hypothermia in cardiac arrest survivors presenting with cardiogenic shock syndrome. Acta Anaesthesiologica Scandinavica, 52, 188-194. Thompson, H. J., Kirknes, C. J. & Mitchell, P. H. Hypothermia and rapid rewarming is associated with worse outcome following traumatic brain injury. Journal of Trauma Nursing, 17(4), 173-177. Torgersen, J., Strand, K., Bjelland, T. W., Klepstad, P., Kvale, R., Soreide, E., Wentzel-Larsen, T., & Flaatten, H. (2010). Cognitive dysfunction and health-related quality of life after a cardiac arrest and therapeutic hypothermia. Acta Anaesthesiologica Scandinavia, 54, 721-728. Read More