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Quiz. Definition & Terminology. 1. What is the most comparable site to the PA for measuring core body temperature? esophageal bladder rectal tympanic. History & Background. Cases & Studies. Mild Hypothermia. Who Else to Cool.

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Quiz

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  1. Quiz Definition & Terminology 1. What is the most comparable site to the PA for measuring core body temperature? • esophageal • bladder • rectal • tympanic History & Background Cases & Studies Mild Hypothermia Who Else to Cool • 2. When body temperature is reduced below 30°C, substantial • risk emerges for cardiac arrhythmias and respiratory arrest as • well as VF and AF • T • F How to Cool Complications & Re-warming Discussion and Test Advanced Hypothermic Life Support Dr. Eric Harrison, MD. – American Society of Hypothermic Medicine

  2. Quiz Definition & Terminology 3. A frequently cited threshold when body temperature is dropping for shivering is 33°C. • T • F History & Background Correct answer: 35.5°C Cases & Studies • 4. EKG abnormality(-ies) associated with temperature in the • range of 30 - 35°C are • bradycardias • prolonged PR interval • prolonged QRS • prolonged QT • all of the above • none of the above Mild Hypothermia Who Else to Cool How to Cool Complications & Re-warming Discussion and Test Advanced Hypothermic Life Support Dr. Eric Harrison, MD. – American Society of Hypothermic Medicine

  3. Quiz Definition & Terminology 5. Patients undergoing cerebral aneurysm clipping had no greater operative blood loss at 32.5-33.5°C than those maintained at 36-37°C. • T • F History & Background Cases & Studies Mild Hypothermia • 6. PaCO2 values obtained from the blood gas machine directly • reflect PCO2 during hypothermia. • T • F Who Else to Cool Correct answer: Use alpha-stat How to Cool • 7. Evidence is largely unsupportive of mild hypothermia effects on • neuroinflammation. • T • F Complications & Re-warming Discussion and Test Advanced Hypothermic Life Support Dr. Eric Harrison, MD. – American Society of Hypothermic Medicine

  4. Quiz Definition & Terminology 8. The beneficial effects of therapeutic hypothermia on ICP have been repeatedly shown in clinical TBI and CVA. • T • F History & Background Cases & Studies • 9. Concerning survival without neurological damage, the HACAS group in Austria and the Australian Bernard group using hypothermic treatment of VF cardiac arrest have shown • 10-14% better outcomes • 15-24% better outcomes • 25-34% better outcomes • 35-44% better outcomes Mild Hypothermia Who Else to Cool How to Cool Complications & Re-warming Discussion and Test Advanced Hypothermic Life Support Dr. Eric Harrison, MD. – American Society of Hypothermic Medicine

  5. Quiz Definition & Terminology 10. The quality of evidence supporting therapeutic hypothermia in non VF cardiac arrest is very high. • T • F History & Background Cases & Studies • 11. Therapeutic hypothermia significantly reduces disability in perinatal encephalopathy. • T • F Mild Hypothermia Who Else to Cool How to Cool • 12. The limited data of non-randomized trials in malignant stroke are not sufficient to recommend therapeutic hypothermia. • T • F Complications & Re-warming Discussion and Test Advanced Hypothermic Life Support Dr. Eric Harrison, MD. – American Society of Hypothermic Medicine

  6. Quiz • 13. Large clinical randomized studies have conclusively demonstrated that therapeutic hypothermia before PTCA limits all types of myocardial infarct size. • T • F Definition & Terminology History & Background Only with AWMI Cases & Studies • 14. During cooling shivering stops at • 35°C • 34°C • 36°C Mild Hypothermia Who Else to Cool How to Cool • 15. Which should you use to adjust ventilation? • alpha-stat • PH-stat which adjusts for temperature Complications & Re-warming Discussion and Test Advanced Hypothermic Life Support Dr. Eric Harrison, MD. – American Society of Hypothermic Medicine

  7. Quiz • 16. Overcooling is detrimental in cardiac arrest patients. • T • F Definition & Terminology History & Background Cases & Studies • 17. Hyperthermic overshoot is not deleterious in TBI and CVA patients. • T • F Mild Hypothermia Correct answer: causes rebound ICP Who Else to Cool • 18. Which of the following re-warming strategies are recommended? • re-warming at a rate no faster than 1°C per 2 hours in CA • re-warming at a rate no faster than 1°C per 4 hours in TBI • re-warming at a rate even slower in severe CVA • not A, B, and C • all A, B, and C How to Cool Complications & Re-warming Discussion and Test Advanced Hypothermic Life Support Dr. Eric Harrison, MD. – American Society of Hypothermic Medicine

  8. Quiz • 19. There are no significant coagulation or clotting problems at • 34° or 33°C in Trauma patients in the therapeutic hypothermia literature. • T • F Definition & Terminology History & Background Cases & Studies • 20. Cooling during CPR reduces the threshold for ventricular defibrillation. • T • F Mild Hypothermia Who Else to Cool • 21. 2L IV 4°C Saline does the following • requires muscular skeletal blocking agents • requires sedation • lowers temperature (core) up to 1.7°C • all of the above • none of the above How to Cool Complications & Re-warming Discussion and Test Advanced Hypothermic Life Support Dr. Eric Harrison, MD. – American Society of Hypothermic Medicine

  9. Quiz • 22. There have been no prospective randomized clinical trails of • therapeutic controlled hypothermia in Trauma patients (TBI) • with hemorrhagic shock. • T • F Definition & Terminology History & Background Cases & Studies • 23. There are NO studies of hypothermic use in acute spinal • cord injury to support systemictherapeutic hypothermia as an option. • T • F Mild Hypothermia Who Else to Cool • 24. Urinary bladder probe temperature is • more reliable than rectal • accuracy is ± 0.4 • 2-4°C lower than brain temp • all of the above • none of the above How to Cool Complications & Re-warming Discussion and Test Advanced Hypothermic Life Support Dr. Eric Harrison, MD. – American Society of Hypothermic Medicine

  10. Quiz • 25. Rectal temperature probe • is unreliable • may have variable position • can perforate • is equal to PA • all of the above • A,B, and C only • none of the above Definition & Terminology History & Background Cases & Studies Mild Hypothermia Who Else to Cool • 26. PA temperature probe or esophageal probe • is the gold standard • In lieu of PA, is best measured in the distal ¼ of the esophagus • frequently inserted in an esophageal ET tube to prevent coiling • all of the above • none of the above How to Cool Complications & Re-warming Discussion and Test Advanced Hypothermic Life Support Dr. Eric Harrison, MD. – American Society of Hypothermic Medicine

  11. Quiz • 27. There is no reduction in cytochrome P450 drug metabolism • during hypothermia. • T • F Definition & Terminology History & Background Cases & Studies • 28. Hypertension appears to be a very common complication of • re-warming in children with TBI. • T • F Mild Hypothermia Correct answer: hypotension Who Else to Cool • 29. Hypothermia has been found to be therapeutic in all but one of these: • VF • hyperthermic CVA • perinatal asphyxia • TBI • OHS How to Cool Complications & Re-warming Discussion and Test Advanced Hypothermic Life Support Dr. Eric Harrison, MD. – American Society of Hypothermic Medicine

  12. Quiz Definition & Terminology • 30. There are specific drug dosage adjustments available for each °C • of hypothermia. • T • F History & Background Cases & Studies • 31. Pancuronuim does not have a receptor effect in humans. • T • F Mild Hypothermia Who Else to Cool How to Cool • 32. Serum neuron-specific enolase (NSE) is a biochemical marker that • can be measured to reflect brain damage. • T • F Complications & Re-warming Discussion and Test Advanced Hypothermic Life Support Dr. Eric Harrison, MD. – American Society of Hypothermic Medicine

  13. Quiz • 33. A landmark paper by Woolf .et.al. supports cooling as soon as • possible and quickest to target temperature. • T • F Definition & Terminology History & Background Cases & Studies • 34. Cooling method rate of cooling (°C/hr) • ice packs to groin • cool air • alcohol + cover • water circulating blanket • Medevance adhesive pads • total body suit MTRF, Akina • Total Body Blanketrol Cincinnati Subzero • KCI cold air total body tent • Complete patient immersion ThermoSuit • Emcools Pre-refrigerated graphite/H2O cube pads with adhesive • Cap Fricap • IV Saline 2L over 30 minutes 4°C 0.3°C / hr Mild Hypothermia 0.3°C / hr 0.25°C / hr 0.3°C / hr Who Else to Cool 1 – 1.2°C / hr 0.9°C / hr How to Cool 1.3°C / hr 0.7°C / hr Complications & Re-warming 3°C / hr 3.3°C / hr Discussion and Test 0.5°C / hr 1.7°C / hr Advanced Hypothermic Life Support Dr. Eric Harrison, MD. – American Society of Hypothermic Medicine

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