Cooling for stroke

[gro2001]

Therapeutic hypothermia for stroke: do you guys do it at your institutions? If you do, how do you do it (what do you use to cool? to control shivering?)

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[xaelia]

Not done here – which is surprising, because we do a lot of probably harmful things to stroke patients in the name of research.

I wasn't aware of any practice-changing evidence upon which to base hypothermia, but, just because I'm unaware doesn't mean it doesn't exist....

 

[WilcoWorld]

Not done here – which is surprising, because we do a lot of probably harmful things to stroke patients in the name of research.

zzzzzzzzzzzzzzzing!

 

[deleted109597]

Therapeutic hypothermia for stroke: do you guys do it at your institutions? If you do, how do you do it (what do you use to cool? to control shivering?)

Pretty much every cooling protocol I've ever seen involves paralysis for shivering.
But we don't have one for stroke here.

 

[Daiphon]

Pretty much every cooling protocol I've ever seen involves paralysis for shivering.
But we don't have one for stroke here.

Ours uses low dose meperidine <cringe> before going to full-blown paralysis...

I've yet to find a good study on the pharmacokinetics of meperidine at cold temps... logically should be slower, but don't know about whether or not normeperidine accumulates; also, ?serotonin syndrome...

Glad it's an upstairs problem. Except it's not. Ugh.

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[Ibuprofen]

You can cool stroke patients...? When did that happen?

I thought cooling was for post cardiac arrests...does it slow brain tissue death?

 

[deleted109597]

I thought cooling was for post cardiac arrests...does it slow brain tissue death?

That's the point. It prevents free oxidative injury in the post resuscitation phase. Whether the blood not going to brain is from heart stopping or thrombus, it's the same concept.

 

[Rendar5]

That's the point. It prevents free oxidative injury in the post resuscitation phase. Whether the blood not going to brain is from heart stopping or thrombus, it's the same concept.

although in the first case, you've fixed the problem, in the second case you may or may not have fixed the problem. just sounds dangerous to me honestly, unless you're talking stroke s/p neurointerventional clot removal.