During clinical this week, the student nurse got the opportunity of an observational experience in a Specialty Care Unit. The student was directed to the Surgical Intensive Care Unit (SICU) to observe a patient that was critically ill and receiving extensive treatment. The student observed a nurse caring for a patient while administering therapeutic hypothermia after cardiac arrest.
The patient L.E. is a 73 year old male. The patient has no history of coronary artery disease or any problems with his heart. Yet, he suffered an event of ventricular fibrillation which he was shocked for followed by a massive heart attack while unaccompanied at a restaurant. Upon arrival to the Southcoast Hospital he went into ventricular tachycardia in the Emergency Room and was shocked a second time. According to the Southcoast critical care manual, these events are part of the inclusion criteria for therapeutic hypothermia after cardiac arrest. He fits the first inclusion criteria listed which is: cardiac arrest with return of spontaneous circulation (ROSC) with initial rhythm of ventricular fibrillation, pulseless ventricular tachycardia, pulseless electrical activity or asystole. The protocol has been provided at the end of the paper.
The Arctic Sun is an experimental study but has various supportive data. When a person such as L.E. experiences a heart attack, one of the body’s responses is increased body temperature. An increased body temperature contributes to ischemic brain damage post cardiac arrest. The Arctic Sun is a system that provides targeted temperature management in the neurologically impaired patient. Pads are placed on approximately 40% of the body and a temperature probe is inserted. L.E. had two temperature probes, a bladder and rectal probe. Then the target temperature is selected and The Arctic Sun was mimics water immersion, which is said to be the most effective means of quickly decreasing core body temperature. The goal is this system neuroprotection and protecting the neurons from apoptosis, or cell death. The lowered temperature helps slow down the ischemia and helps the heart heal. There are several stages to inducing the hypothermia. There is the cooling procedure which includes induction, cooling methods, the connection of the Arctic Sun, sedation, and maintenance of the hypothermia. Then there is the re-warming phase which consist of passive rewarming and the controlled re-warming by the Arctic Sun. The student observed this patient during the maintenance of the hypothermia which lasts twenty four hours.
The implementation of the Arctic Sun is a very complex ordeal and requires meticulous care by the nurse. The first objective being discussed is the role of the nurse in the specialty unit. The role of the nurse in the SICU was difficult because it forces the nurse to continuously multi-task. The specific nurse the student observed was administering the Arctic Sun for the second time during her career. When...