The first protocol (above) is from Wake County EMS. This protocol utilizes external cooling with ice packs and internal cooling via IV with cold saline. A supervisor responds to every cardiac arrest in Wake County and provides the cold saline. They have a small refrigerator in each supervisor vehicle. Wake also utilizes paralytics within this protocol. They use paralysis to bypass shivering; since shivering counteracts hypothermia. A non-depolarizing paralytic to avoid the fasciculations which are a side effect of depolarizing paralytics.
The second protocol (below) is from my own service, Lee County EMS. It is a little more basic and we do not utilize paralytics. We don't monitor temperatures, as of yet, either. We utilize this protocols for post-ventricular fibrillation arrests with ROSC. We have a refrigerator in every ambulance for our Cardizem, Succs, Ativan, and Cold Saline. We use the same cooling measures as Wake. We do not have any data yet, this was just started at the beginning of this year.
Click here to read a 2003 article from Circulation, the journal of the American Heart Association.
Click here for quite a bit of information provided by Wake County EMS
2 comments:
To give an update, Wake County has moved paralytics further down in the protocol. The 2009 update can be found here-
http://www.wakegov.com/NR/rdonlyres/F6A5BE36-225E-4FC7-8F13-8CC71FD8700C/0/2009protocolupdates.pdf
The reason for the change is that we have not seen the shivering since we started IH here.
The refridgeration units are carried on our District Chief units (5 in the county 24/7) as well as the new Advanced Practice Paramedics (5 on duty during the day and 2 at night). Google "Wake County, Advanced Practice Paramedic" to learn more.
APP procedures are indicated in the 2009 update by the 'A' designation.
9E1
Thanks, I did not know there was a more current version.
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