5 ms·

Because it's hard. I helped out at a company among many that are trying to develop a system that would allow you to do this in ambulance and they started testin

Because it's hard. I helped out at a company among many that are trying to develop a system that would allow you to do this in ambulance and they started testing prototypes 10 years ago and have yet to progress from that stage.

sho_hn 7y ago
Can you talk about the problems involved?
JshWright 7y ago
It's not that hard... you just throw some ice packs in the groin and armpits. You won't get them fully into the TTM range in a 20 minute transport, but you can start the process.
- dsfyu404ed 7y ago
  Sticking ice in proximity to major arteries is going to be a lot less effective without a beating heart to circulate all that newly cold blood.
  - JshWright 7y ago
    This procedure is initiated after the heart has been restarted[1]. You're absolutely correct that it's pointless to do it earlier, especially since the far more important thing is getting the heart beating again. [1] This is known as "targeted temperature management" (TTM), and is part of the standard post-ROSC (return of spontaneous circulation) algorithm in ACLS (Advanced Cardiac Life Support), if you're looking for terms to Google.
  - agumonkey 7y ago
    the cold won't distribute at all ?
    - dsfyu404ed 7y ago
      It will but much more slowly. Think of cooling the blood as using the surface area of the arteries and veins as a heat sink to cool the body. Without that blood moving your next best heat sink is the skin so start piling on the ice.
      - JshWright 7y ago
        The body itself is the heat sink. The skin is a radiator. The blood is the liquid in a liquid cooling system (moving heat from the sink to the radiator). To your point, liquid cooling systems become _much_ less effective when the liquid stops pumping.
      - agumonkey 7y ago
        So I guess ice and cardiac massaging are synergic.
- t0mbstone 7y ago
  Sounds like a good way to introduce frostbite
  - meowface 7y ago
    I don't know the exact implications, but I'd probably rather have frostbite or even lose a limb than have serious permanent brain damage.
  - JshWright 7y ago
    Those spots are not prone to frostbite, since the "coldness" gets distributed through the rest of the body very quickly (apologies for playing a little fast and loose with thermodynamics there). This is why they're used in the first place to cool the person quickly.
    - deleted 7y ago
      [deleted]
- tapland 7y ago
  That is extremely ineffective. What you might want to do is to cool the brain through cooling the outside of the head as well as through the nasal cavity. Even if you chug a giant slurpee the largest effect on the brain temperature will be the cooling of the nasal cavity on it's way down.
  - JshWright 7y ago
    Packing with ice packs is a standard component of TTM, generally in conjunction with other therapies (chilled IV fluids, etc). It's also the easiest step to take in a prehospital setting, which is why we do (this is a thing I've done with maybe a dozen patients over the past few years). I'm not just making this stuff up, it's based on actual treatment protocols and algorithms. We're talking about a naked, sedated patient (so they're already losing a lot of heat due to simple convection, and there's no heat being generated by skeletal muscle movements). The body's metabolism has slowed significantly, and it's producing anywhere near the normal level of "baseline" heat.
    - tapland 7y ago
      Do you have any links to data showing effects on brain temperature from that treatment? Afaik interest has been low in carrying around enough ice pack capacity to make this viable, and with lacking data for it even working, whereas head-cooling packs with circulating liquid through a cooler takes little space, cools way more efficiently and required no other maintenance after insertion into the patient in the ambulance (and is moved with the patient while continously working).
      - JshWright 7y ago
        Overcooling is more of a risk with I've packs than not cooling enough. It's much less of a concern in a prehospital setting though, since we're not with the patient that long. It's more of an issue in the ICU. https://www.ncbi.nlm.nih.gov/pubmed/17114983 https://www.ncbi.nlm.nih.gov/pubmed/17114983

sho_hn 7y ago

Can you talk about the problems involved?

JshWright 7y ago

It's not that hard... you just throw some ice packs in the groin and armpits. You won't get them fully into the TTM range in a 20 minute transport, but you can start the process.

dsfyu404ed 7y ago
Sticking ice in proximity to major arteries is going to be a lot less effective without a beating heart to circulate all that newly cold blood.
- JshWright 7y ago
  This procedure is initiated after the heart has been restarted[1]. You're absolutely correct that it's pointless to do it earlier, especially since the far more important thing is getting the heart beating again. [1] This is known as "targeted temperature management" (TTM), and is part of the standard post-ROSC (return of spontaneous circulation) algorithm in ACLS (Advanced Cardiac Life Support), if you're looking for terms to Google.
- agumonkey 7y ago
  the cold won't distribute at all ?
  - dsfyu404ed 7y ago
    It will but much more slowly. Think of cooling the blood as using the surface area of the arteries and veins as a heat sink to cool the body. Without that blood moving your next best heat sink is the skin so start piling on the ice.
    - JshWright 7y ago
      The body itself is the heat sink. The skin is a radiator. The blood is the liquid in a liquid cooling system (moving heat from the sink to the radiator). To your point, liquid cooling systems become _much_ less effective when the liquid stops pumping.
    - agumonkey 7y ago
      So I guess ice and cardiac massaging are synergic.
t0mbstone 7y ago
Sounds like a good way to introduce frostbite
- meowface 7y ago
  I don't know the exact implications, but I'd probably rather have frostbite or even lose a limb than have serious permanent brain damage.
- JshWright 7y ago
  Those spots are not prone to frostbite, since the "coldness" gets distributed through the rest of the body very quickly (apologies for playing a little fast and loose with thermodynamics there). This is why they're used in the first place to cool the person quickly.
  - deleted 7y ago
    [deleted]
tapland 7y ago
That is extremely ineffective. What you might want to do is to cool the brain through cooling the outside of the head as well as through the nasal cavity. Even if you chug a giant slurpee the largest effect on the brain temperature will be the cooling of the nasal cavity on it's way down.
- JshWright 7y ago
  Packing with ice packs is a standard component of TTM, generally in conjunction with other therapies (chilled IV fluids, etc). It's also the easiest step to take in a prehospital setting, which is why we do (this is a thing I've done with maybe a dozen patients over the past few years). I'm not just making this stuff up, it's based on actual treatment protocols and algorithms. We're talking about a naked, sedated patient (so they're already losing a lot of heat due to simple convection, and there's no heat being generated by skeletal muscle movements). The body's metabolism has slowed significantly, and it's producing anywhere near the normal level of "baseline" heat.
  - tapland 7y ago
    Do you have any links to data showing effects on brain temperature from that treatment? Afaik interest has been low in carrying around enough ice pack capacity to make this viable, and with lacking data for it even working, whereas head-cooling packs with circulating liquid through a cooler takes little space, cools way more efficiently and required no other maintenance after insertion into the patient in the ambulance (and is moved with the patient while continously working).
    - JshWright 7y ago
      Overcooling is more of a risk with I've packs than not cooling enough. It's much less of a concern in a prehospital setting though, since we're not with the patient that long. It's more of an issue in the ICU. https://www.ncbi.nlm.nih.gov/pubmed/17114983 https://www.ncbi.nlm.nih.gov/pubmed/17114983