Pt. Name & MR
		
Age
		
BMI
		
Date of Admission to PPMC
		
Date of Arrest
		
Unit Cooled In
	      CCU                        MICU                     SICU	
Was cooling started in ED?
	            Y                        N	
Location of Arrest (Out of hospital or In hospital)
	       Out of Hosp.                     In hosp.	
Arrest Cause
	           VT/VF            Asystole                PEA	
Time Arrest Occurred
		
Time cooling started
		
Time it took to get to goal time (from time cooling started)	Hours	
Total Time at Goal Temp
	Hours	
Was Temp < 32 degrees during cooling?
Lowest temp?	             Y                         N	
Time rewarming started
		
Time rewarmed to 36 degrees
		
Max temp after rewarming complete (look at 48 hours after pt re-warmed) 		
Paralytics Used?
	            Y     (drip)                             N
            Y     (bolus only)                  If NO, Why Not?
             	
Cooling related skin breakdown?
	             Y                         N	
Time EEG Placed on Pt (check paper chart note)
		
Lowest BIS Score during cooling
		
Comorbidities contributing to arrest

		
Survival to hospital D/C?
	             Y                         N	
Neuro Status at D/C WDL?
	            WDL                  Other___________________	
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