Unique Plan Description: Rewarming for TTM (MHWH)
Plan Selection Display: Rewarming for TTM (MHWH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2024-01-23 10:21:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-01-23 10:21:00
Available at all facilities: No

Rewarming for TTM (MHWH)
Vital Signs
	Therapeutic Hypothermia Device
		T;N
			Comment: Set machine to increase temperature 0.25C/hour to target temperature of 37 C (98.6F). Maintain the machine at 37 C (98.6F) for 48 hours once target temperature has been achieved. Do not allow hyperthermia (37.5C/99.5F) in the first 48 hours after cooling phase. After 48 hours discontinue machine and protocol.
Diagnostic Tests
	Echo w Doppler resting
		T;N, Routine, Indication: Cardiac arrest
Medications
	calcium gluconate IVPB
		1 gm, INT, IVPB, Q6H, PRN see comment, 100 ml/hr, duration: 24 hr
			Comment: for ionized calcium <1
	potassium chloride IVPB - Central line
		40 mEq, Injection-Premix, IVPB, Q6H, PRN see comment, infuse over 4 hr, duration: 24 hr
			Comment: Once normothermia achieved if K+ <3.5 and if no evidence of CKD/AKI
Patient Care
	Notify MD
		T;N, Once normothermia reached and maintained for 48 hours for updated RASS goal parameters and weaning of sedation agents. Ensure sedation agents through Mechanical Ventilation power plan are addressed as needed.
	Discontinue Medication
		T;N, Once rewarming temperature reached and maintained for 48 hours, Discontinue Shivering protocol and any orders/medications associated with shivering.
		T;N
			Comment: if patient has received a neuromuscular blockade (NMB), solely to prevent shivering, discontinue the NMB before the sedative/analgesic agents. Do not decrease sedative/analgesic until 8 hours after last dose of NMB or train of four response 4/4. If No NMB has been used, sedation and analgesia may be weaned and sedation awakening trials attempted
		T;N, , insulin drip protocol 24 hrs after patient has been rewarmed and begin Insulin Sliding Scale Novolog Level 1
Consults/Follow-up
	Consult Neurologist
		Reason for Referral: 72 hours post-arrest
	Pharmacy Consult
		Transitioning off shivering protocol and sedation titration to BSAS. Ensure sedation agents ordered thru Mechanical Vent Powerplan

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase