Neurologic injury is the most common cause of mortality in clients who have had cardiac arrest, particularly ventricular fibrillation or pulseless ventricular tachycardia. Inducing therapeutic hypothermia in these clients within 6 hours of arrest and maintaining it for 24 hours has been shown to decrease mortality rates and improve neurologic outcomes. It is indicated in all clients who are comatose or do not follow commands after resuscitation.
The client is cooled to 89.6-93.2 F (32-34 C) for 24 hours before rewarming. Cooling is accomplished by cooling blankets; ice placed in the groin, axillae, and sides of the neck; and cold IV fluids. The nurse must closely assess the cardiac monitor (bradycardia is common), core body temperature, blood pressure (mean arterial pressure to be kept >80 mm Hg), and skin for thermal injury. The nurse must also apply neuroprotective strategies such as keeping the head of the bed elevated to 30 degrees. After 24 hours, the client is slowly rewarmed.
(Option 1) It is too early to consider a do-not-resuscitate order. If the client does not respond to therapeutic hypothermia or there is evidence of neurologic impairment, it may be discussed at some point.
(Option 3) Clients are generally kept NPO during therapeutic hypothermia and rewarming. The feeding tube may be needed after that time.
(Option 4) Passive range-of-motion exercises would be indicated for this client but are not the immediate priority.
Educational objective:
Following return of spontaneous circulation in an out-of-hospital cardiac arrest, therapeutic hypothermia should be implemented for 24 hours in clients who are comatose or do not follow commands. Therapeutic hypothermia has been shown to improve neurologic outcomes and decrease mortality in these clients.
Neurologic injury is the most common cause of mortality in clients who have had cardiac arrest, particularly ventricular fibrillation or pulseless ventricular tachycardia. Inducing therapeutic hypothermia in these clients within 6 hours of arrest and maintaining it for 24 hours has been shown to decrease mortality rates and improve neurologic outcomes. It is indicated in all clients who are comatose or do not follow commands after resuscitation.
The client is cooled to 89.6-93.2 F (32-34 C) for 24 hours before rewarming. Cooling is accomplished by cooling blankets; ice placed in the groin, axillae, and sides of the neck; and cold IV fluids. The nurse must closely assess the cardiac monitor (bradycardia is common), core body temperature, blood pressure (mean arterial pressure to be kept >80 mm Hg), and skin for thermal injury. The nurse must also apply neuroprotective strategies such as keeping the head of the bed elevated to 30 degrees. After 24 hours, the client is slowly rewarmed.
(Option 1) It is too early to consider a do-not-resuscitate order. If the client does not respond to therapeutic hypothermia or there is evidence of neurologic impairment, it may be discussed at some point.
(Option 3) Clients are generally kept NPO during therapeutic hypothermia and rewarming. The feeding tube may be needed after that time.
(Option 4) Passive range-of-motion exercises would be indicated for this client but are not the immediate priority.
Educational objective:
Following return of spontaneous circulation in an out-of-hospital cardiac arrest, therapeutic hypothermia should be implemented for 24 hours in clients who are comatose or do not follow commands. Therapeutic hypothermia has been shown to improve neurologic outcomes and decrease mortality in these clients.
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Whether your fun is fine dining, a quick bite,
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Crown Resort’s six star hotel makes up the lower levels of the tower from levels 6 to 32, including the protruding lower south east wing of the building. The casino floor along with bars, restaurants and other hospitality venues occupy the podium of the tower. In June 2016, the casino received final approval from the Planning Assessment Commission on condition that the casino met needs proposed by the commission, including adequate public spaces and access. These concepts mostly centred around a 213 metres (699 feet) tall hotel tower built on a pier extended 150 metres (490 feet) into the harbour. It was developed by Crown Resorts, primarily comprising a hotel and residential apartments, while a casino and other hospitality venues make up the rest of its floorspace.
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IReserve is a new feature now available on electronic gaming machines exclusively for
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are outlined in the Terms section of each venue’s webpages.
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