Head of bed at 30 degrees
Goal MAP 80 - 100 mmhg
Titrate with norepinephrine (start 2-4 mcg/min) if EF > 50%
Titrate with dobutamine (start 2.5-20 mcg/kg/min) if EF < 50%
IV nitroglycerin starting at 10 mcg/min if hypertensive
Check skin q2-6 hrs for cold injury
Maintain normoglycemia
Do not treat hyperglycemia aggressively, as enzymatic functions are decreased at low temperatures, and rebound hypoglycaemia possible with rewarming
Replete K, Mg, Phos, Ca<unk>  induced diuresis is expected)
Common unconcerning ECG findings during cooling - Osborne wave, HR < 40 bpm
Consider continuous EEG within 6 hrs, no later than 12 hrs after onset of cooling
Stress dose steroids for adrenal insufficiency
?Seizure prophylaxis
Titrate with norepinephrine (start 2-4 mcg/min) if EF > 50%
Titrate with dobutamine (start 2.5-20 mcg/kg/min) if EF < 50%
IV nitroglycerin starting at 10 mcg/min if hypertensive
Do not treat hyperglycemia aggressively, as enzymatic functions are decreased at low temperatures, and rebound hypoglycaemia possible with rewarming
ABG q6 hrs for duration of<unk> 
CBC, Coags, BMP, Mg, Phos q6 hrs for duration of<unk> 
Expect decreased K, Ca, Mg, Phos during, and rebound at rewarming
Hyperglycemia as metabolism slows at low temperature and body develops insulin resistance
Troponins, CK-MB q6 hrs x2 days
Lipase, LFTs (if abnormal, no need to intervene unless persistent after rewarming)
Other - Cortisol, UA, Pan-cultures, tox screen
Expect decreased K, Ca, Mg, Phos during, and rebound at rewarming
Hyperglycemia as metabolism slows at low temperature and body develops insulin resistance
Rewarm ABG to 37C for analysis (controversial)
A warmed ABG from a<unk>  patient will show a  higher PaO2, higher PaCO2, and a lower pH than that actually present in the patient’s blood in vivo
PaO2 is decreased by 5 mmHg for each degree below 37C
PaCO2 is decreased by 2 mmHg for each degree below 37C
Change in pH = 0.015 pH units per degree C change in temperature
If measured pH is 7.360 at 37C, then the pH at 34C is calculated as follows:
pH = [7.360 + (37-34)(0.015)] = 7.405
PaO2 is decreased by 5 mmHg for each degree below 37C
PaCO2 is decreased by 2 mmHg for each degree below 37C
Change in pH = 0.015 pH units per degree C change in temperature
If measured pH is 7.360 at 37C, then the pH at 34C is calculated as follows:
pH = [7.360 + (37-34)(0.015)] = 7.405
If measured pH is 7.360 at 37C, then the pH at 34C is calculated as follows:
pH = [7.360 + (37-34)(0.015)] = 7.405
pH = [7.360 + (37-34)(0.015)] = 7.405
ECG q8 rule out ACS
Arterial line
Foley with temperature probe
CVP, ScvO2
Consider head CT
Consider CTPE study
GI prophylaxis
Modify prophylactic heparin or LMWH dosing as there is<unk>  coagulopathy
No clear best way for monitoring of anticoagulation until further studies
Consider modified dosing:
Heparin 40 units IV bolus
Followed by 7 u/kg/hr during TH with scheduled repeated coags, plus or minus heparin levels
No clear best way for monitoring of anticoagulation until further studies
Consider modified dosing:
Heparin 40 units IV bolus
Followed by 7 u/kg/hr during TH with scheduled repeated coags, plus or minus heparin levels
Heparin 40 units IV bolus
Followed by 7 u/kg/hr during TH with scheduled repeated coags, plus or minus heparin levels
Therapeutic hypothermia
Ventriculoperitoneal shunt drainage
ICU sedation
Extracorporeal membrane oxygenation
Traumatic asphyxia
Ventriculoperitoneal shunt obstruction
Advanced airway adjuncts
Neonatal resuscitation