Mild hypothermia

[mattlott]

In light of the NFL play who suffered a severe spinal cord injury this weekend mild hypothermia might be comming to an ambulance near you.

How would we do this on a practical day to day basis?

see article below:

(Buffalo, NY, September 11, 2007) - - We have some breaking news about the condition of bills tight end Kevin Everett. Doctor Peter Ostrow reports with some hopeful news.

I spoke with Dr. Andy Cappuccino, one of his surgeons, Tuesday, and he was much more optimistic than yesterday. He said Kevin Everett is able to move his arms and legs, a great advance since yesterday.

All of us who saw the injury during the football game and heard the early reports feared the worst, but many things went right for Kevin Everett. The Bills' training staff practices for situations just like this and they were ready. Dr. John Marzo led the drill, and trainer Bud Carpenter immobilized Kevin's head.

As soon as they put him inthe ambulance, treatment began. He was given steroids as the ambulance went through the tunnell, and two IV's were inserted so he could be given a treatment that would lower his body temperature. Within an hour of the time thay reached Millard Fillmore Gates, he had a CT Scan and an MRI Scan, and within an hour and a half, Dr. Cappuccino and Dr. Kevin Gibbons began surgery and it went very well.

Dr. Andrew Cappuccino, Othopedic Surgeon, "The spinal cord was completely decompressed, and the spine was fixated from the back with four screws and two small rods. At that point in time, an intraoperative ultrasound or doppler study was performed to evaluate the cord, the covering of the cord and the cord itself were completely intact, and actually looked good."

The doctors were reluctant to give an optimistic prognosis, but there were some early hopeful signs.

Dr. Andrew Cappuccino, Othopedic Surgeon, "This examination, about 6 hours after surgery did show voluntary movement of his legs in his adductors, the muscles that ppull his legs together, and his plantarflexors the muscles that push his feet down."

And Kevin himself, in a message to his mother, gave the most optimistic prediction.

Dr. Andrew Cappuccino, Othopedic Surgeon, "He told her that he was going to get better and he didn't want her to worry."

And Tuesday, Dr Cappuccino says, "We may be wittnessing a minor miracle." He said that because, today, Kevin Everett was able to voluntarily move his arms and legs, a marked improvement over yesterday. He also noted that the MRI scan taken after the surgery showed only a small amount of swelling in the cord. Those are both good signs.

[Q] You said they lowered his body temperature. What did that do?

[A] Its one of the things that prevents the cord from swelling, along with the steroids. The treatment protocol was designed by Dr. Barth Green in Miami, who happens to be a personal friend of Ralph Wilson.

_________________

International Herald Tribune

NFL: Optimism on Kevin Everett spinal cord injury

By Matt Higgins

Wednesday, September 12, 2007

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BUFFALO, New York: Two days after he was paralyzed during a game, and one day after doctors described his condition as potentially life-threatening, Buffalo Bills tight end Kevin Everett was moving his arms and legs.

The doctor who performed surgery on Everett, Andrew Cappuccino, said Everett's condition had "improved."

Another doctor, who has consulted with Cappuccino, said Tuesday that Everett could eventually walk out of the hospital.

"Kevin Everett is moving his arms and legs, his legs stronger than his arms," said the consulting neurosurgeon, Dr. Barth Green. "He's moving them both to a point, to a degree that he will end up walking. He will walk out of the hospital."

On Monday afternoon, Cappuccino, an orthopedic spinal surgeon, described Everett's chances of a complete recovery as "unlikely" and in the range of 5 to 10 percent.

The next day, however, Green said he had spoken to Cappuccino and described him as "elated."

"I think he's walking on clouds right now," Green said. "Any physician would be.

"What he told you yesterday is the case 99 percent of the time. That is that people who are paralyzed stay paralyzed."

On Monday, team doctors said Everett, a 25-year-old backup tight end, was paralyzed from the shoulders down and in life-threatening condition after a collision Sunday during a 15-14 loss to the Denver Broncos.

Everett was injured on the second-half kickoff while attempting what appeared to be a routine tackle of Domenik Hixon. But after striking his helmet on Hixon's shoulder pads, Everett immediately collapsed. He lay motionless for about 15 minutes.

The Bills' team physician, Dr. John Marzo, described Everett as conscious and alert on the field but unable to move his extremities. Everett was immobilized using a back board and taken by ambulance to the hospital.

During the ride, Cappuccino began lowering Everett's body temperature to protect his brain, spinal cord and other organs.

At the hospital, Cappuccino operated for four hours Sunday night to repair damage to Everett's third and fourth cervical vertebrae and spinal cord. Cappuccino said that Everett had suffered direct compression of his spinal cord between the C-3 and C-4 vertebrae, but that the spinal cord was not snapped.

Reached by phone Tuesday night, Cappuccino said he was not permitted by the Bills to comment further.

Green is chairman of neurosurgery at the University of Miami. He is also president of The Miami Project to Cure Paralysis, a foundation he started with the NFL Hall of Fame linebacker Nick Buoniconti, after Buoniconti's son Marc had a spinal cord injury in 1985 while playing football for The Citadel, a college in South Carolina.

Green is also friends with the Bills' owner, Ralph Wilson, who has helped support The Miami Project.

Green said the fact that Cappuccino lowered Everett's temperature to 92 degrees Fahrenheit (33.3 Celsius) immediately after the injury made a difference in his recovery.

The procedure is called moderate hypothermia.

"It's like a bruising of an arm, an ice pack will help," Green said. "The vascular system was the ice pack for Everett's spinal cord."

Dr. Joseph Torg, professor of orthopedics at Temple University in Philadelphia, said Tuesday that it was difficult to make generalizations with spinal cord injuries.

"You want to see improvement in the first 24 to 72 hours if the individual will have a normal recovery," Torg said. "Every case is unique. You can't close any doors any way this early.

"The fact he has some spinal cord function is extremely optimistic."

Players for the Bills were unavailable for comment.

"It's a dangerous game, and yesterday we saw that and it came right to us," Coach Dick Jauron of the Bills said Monday. "It was right in front of us. It was one of our teammates down on the field."

[firespec35]

So were they just using cooled fluids or did they use a drug to lower his body temp? Sounds like a cool Idea either way. Would love to see it come to fruition in protocols. We have a lot of HS football games and I've had that kid that can't feel or move anything below his neck after taking a hit. The feeling of helplessness I had that day was huge.

[Just Plain Ruff]

More than likely they initially used cooling blankets to cool this guy down. Not sure what medication you would use to cool someone down. I don't know of any that are out there.

Hypothermia is going to be the next big thing in ROSC for cardiac arrest. As a matter of fact there will be an article in one of the upcoming Fieldmedics magazine issues. Probably the January issue.

[CBEMT]

It was on the national news tonight. They used chilled IV saline.

[firespec35]

I'm lucky if I can catch the news once a week. Thanks for the info

[ERDoc]

Apparently a huge course of events was set in place when Everrett went down. The following is from an AP article. If we start cooling saline with ice in the ambulance, where are you guys going to keep your lunches?

Everett suffered a fracture and dislocation of his spinal cord in the neck area during a game Sunday night against the Denver Broncos. Watching it on television from home was Dr. W. Dalton Dietrich, scientific director for the Miami Project, a spinal cord program affiliated with the University of Miami Miller School of Medicine.

The program is among several in the United States that has led research into moderate hypothermia, or cooling the body a few degrees to try to limit swelling, inflammation and the cascade of events and chemicals that cause further damage after an initial neurological injury.

Dietrich sent an urgent e-mail to fellow neurosurgeon Dr. Barth Green, who knows Buffalo Bills owner Ralph Wilson.

Who did what next is unclear, but doctors say Everett received the experimental cooling therapy in the ambulance, even before X-rays and other tests could show the extent of his injury and the treatment he would need.

[spenac]

Cool, literally. It will be neat to see how the future improvements to care occur. Between trauma and cardiac and probably others yet released hypothermia may become common place treatment in pre-hospital care. I had read of this being done in bloodless surgery. It makes sense that we use the bodies own defense systems.

[Dustdevil]

Geeze... that's gotta result in the mother of all brain freeze. :?

I'll pass. Just give me steroids.

[spenac]

Geeze... that's gotta result in the mother of all brain freeze. :?

I'll pass. Just give me steroids.

So no slushy for you?

I look forward to seeing how much better, if better, cooling is to steriods.

[Kim_Possible]

Well, I guess once we start cooling the fluids, we won't have any room for beer.

Yet the thing is, are we going to continue to have warm fluids also, or is this option being steered away.