Bridge Orders For Induced Hypothermia Post-Cardiac Arrest Page 2
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2Authorization is hereby given to dispense the generic equivalent unless otherwise indicated by the physician
DATE
TIME
Interventions and Treatments:
6.
Initial ventilator setting: until seen by Pulmonary Associates
[ ]
[ ]
Ventilator Mode Settings:
AC
SIMV
Rate:
FiO
:
Vt:
PEEP:
PSV:
2
SpO
Goal: 94 to 96% / PaO
Goal: 80 – 120 mm Hg
2
2
Ensure ventilator humidifier is OFF until rewarming phase is initiated
7.
Place foley catheter on arrival to CMICU
Medications::
8.
Pain and Sedation Medication Management
IV Bolus – NOTE: These medications can be used in the Induction Phase and/ or the Maintenance Phase.
Select one choice only
[ ]
Midazolam (Versed) 1 mg IV every 30 minutes PRN for sedation
[ ]
Fentanyl 50 mcg IV every 30 minutes PRN for sedation and / or pain
[ ]
Morphine 2 mg IV every hour PRN pain
Neuromuscular Blocking Agents may not be necessary at a body temperature below 35° C. TOF may be unreliable if
hypothermic setting and not recommended. Duration of paralytic action may be prolonged in hypothermic patients.
9.
Neuromuscular Blocking Agents for Shivering Suppression:
Select one choice only
[ ]
Norcuron (Vecuronium) 0.1 mg per kg IV bolus x 1 dose. May repeat every 30 minutes up to a total
of 3 additional doses. (Discontinue this order when rewarming phase begins)
For known Renal and/ or Hepatic dysfunction consider:
[ ]
Nimbex (Cisatricurium) 0.2 mg per kg IV bolus x 1 dose. May repeat every 30 minutes up to a total
of 3 additional doses. (Discontinue this order when rewarming phase begins)
10. If initial magnesium level is less than or equal to 2.0 – administer magnesium 2 grams IV over 2 hours STAT –
DO NOT DELAY THIS INFUSION
A MAP of 70 to 100 mm Hg during treatment should be maintained to provide adequate end organ perfusion. Heart
rates less than 40 are common. This alone is not cause for concern in the absence of other evidence of hemodynamic
instability.
11. Hypotensive Management:
For MAP less than 70 mm Hg and / or CVP less than 10 cm H
O, give 500 ml refrigerated 0.9% Normal
2
saline IV bolus, may repeat x 1 to achieve desired results; if increase in MAP not achieved, continue fluids and
start:
For symptomatic bradycardia, consider Dopamine as first choice
[ ]
Dopamine 400 mg in 250ml Normal saline: initiate at 5 mcg / kg / minute PRN for a MAP less than 70 mm
Hg and/or heart rate less than 40 bpm. Titrate up or down by 2 mcg / kg / min every 15 minutes to achieve
a MAP of 70 to 100 mm Hg, up to a maximum dose of 20 mcg / kg / min
[ ]
Neosynephrine (Phenylephrine) 40 mg in 250 ml Normal saline: initiate at 100 mcg per minute PRN for
MAP less than 70 mm Hg. Titrate up or down by 25 mcg per min every 15 minutes to achieve a MAP 70
to 100 mm Hg, up to a maximum dose of 300 mcg / min
[ ]
Levophed (Norepinephrine) 4 mg in 250 ml Normal saline: initiate at 2 mcg / minute PRN for a MAP
less than 70 mm Hg. Titrate up or down by 2 mcg / min every 15 minutes to achieve a MAP of 70 to 100
mm Hg, up to a maximum dose of 30 mcg / min
Signature __________________________________________________________ Date _______________ Time _______________
Henrico Doctors’ Hospital
Patient Identification
Bridge Orders for Induced Hypothermia Post-Cardiac Arrest
(
Page 2 of 2)
HDH.HOSP#167 (11/10)
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