Jananis’ sister found her hanging from the deck with a dog chain around her neck, approximately fifteen minutes after having last seen her. Her mother attempted CPR whilst she remained hanging, and it was a further 15 minutes before she was extricated by the fire brigade. Return of spontaneous circulation (ROSC) was estimated at thirty to forty minutes from assumed time of hanging. She was intubated at the scene and no inotropes were required to maintain an adequate systemic blood pressure. At the local hospital magnetic resonance imaging (MRI) was completed to rule out brain haemorrhage. Following initial and ongoing interventions, neuroprotective cares were instigated in order to minimize further neural damage, secondary injury, which
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HIE or injury (HII), is a cerebral injury caused by inadequate oxygen delivery, in this case from the hiatus in blood flow during cardiac arrest, and the subsequent period of reduced cardiac output (Gaillard & Di Muzio, 2017). Initial interventions included, but were not limited to, airway management - establishment of a secure and patent airway, and commencement of best practice invasive ventilation (Ventilation in PICU, n.d.), with tidal volumes of 6-8mls/kg to ensure optimal systemic and cerebral perfusion, circulation, evaluation of level of consciousness using Glasgow Coma Scale (GCS), pupil sizes and response to light.
The GCS was devised in 1974 as a universal tool to assess “the depth and duration of impaired consciousness and coma” (Jennett & Teasdale, 1974, as cited in Braine & Cook, 2016) and the numerical score based on three parameters provides an indication of the potential severity of brain injury. A secondary survey was performed to check skin integrity and any visible injuries. ADHB trauma guidelines (2011), uses a visual reference guide to conduct a secondary survey in order to complete a full physical examination after resuscitation has successfully been …show more content…
Peripheral probes may register a lower temperature in this patient population (Kaukuntla et al 2004), whilst rectal and bladder temperatures measurements are less responsive in hypothermic situations (Weingart, 2009). Janani’s temperature was 33 degrees Celsius so she was correspondingly placed on a cooling blanket to initiate immediate gradual warming to normothermia, using the Targeted Temperature Management (TTM) protocol (ADHB, 2016). Although maintaining hypothermia post cardiac arrest in adults has been shown to improve outcomes, there is no evidence to recommend hypothermic treatment in paediatrics, (Scholefield et al, 2013), (Yuknis et al, 2016). Interestingly, the Cool Kids Trial comparing hypothermic versus normothermic treatment was aborted due to futility (Adelson, 2013). Hyperthermia, conversely, has been shown to have disastrous consequences on neurological recovery (Bembea, 2010, as cited in Scholefield et al, 2013), and Yuknis et al (2016) found strategic temperature management after cardiac arrest reduced pyrexias more effectively than transient
HIE or injury (HII), is a cerebral injury caused by inadequate oxygen delivery, in this case from the hiatus in blood flow during cardiac arrest, and the subsequent period of reduced cardiac output (Gaillard & Di Muzio, 2017). Initial interventions included, but were not limited to, airway management - establishment of a secure and patent airway, and commencement of best practice invasive ventilation (Ventilation in PICU, n.d.), with tidal volumes of 6-8mls/kg to ensure optimal systemic and cerebral perfusion, circulation, evaluation of level of consciousness using Glasgow Coma Scale (GCS), pupil sizes and response to light.
The GCS was devised in 1974 as a universal tool to assess “the depth and duration of impaired consciousness and coma” (Jennett & Teasdale, 1974, as cited in Braine & Cook, 2016) and the numerical score based on three parameters provides an indication of the potential severity of brain injury. A secondary survey was performed to check skin integrity and any visible injuries. ADHB trauma guidelines (2011), uses a visual reference guide to conduct a secondary survey in order to complete a full physical examination after resuscitation has successfully been …show more content…
Peripheral probes may register a lower temperature in this patient population (Kaukuntla et al 2004), whilst rectal and bladder temperatures measurements are less responsive in hypothermic situations (Weingart, 2009). Janani’s temperature was 33 degrees Celsius so she was correspondingly placed on a cooling blanket to initiate immediate gradual warming to normothermia, using the Targeted Temperature Management (TTM) protocol (ADHB, 2016). Although maintaining hypothermia post cardiac arrest in adults has been shown to improve outcomes, there is no evidence to recommend hypothermic treatment in paediatrics, (Scholefield et al, 2013), (Yuknis et al, 2016). Interestingly, the Cool Kids Trial comparing hypothermic versus normothermic treatment was aborted due to futility (Adelson, 2013). Hyperthermia, conversely, has been shown to have disastrous consequences on neurological recovery (Bembea, 2010, as cited in Scholefield et al, 2013), and Yuknis et al (2016) found strategic temperature management after cardiac arrest reduced pyrexias more effectively than transient