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April 1, 2013
The hot topic of hypothermia in trauma
Trauma is the leading cause of death in humans from age 1 through 44.1 As EMS providers, we are trained to assess and manage severely injured patients.
Ongoing research has refined the way we treat trauma, such as minimizing the use of spinal immobilization, reducing the amount of intravenous fluids in hypovolemia and reducing the use of an advanced airway when ventilating a brain injured patient.
One area of trauma resuscitation receiving increasing scrutiny is the control of body temperature when a patient is severely injured. Unintentional hypothermia is one leg of the so-called "lethal triad" of conditions that can cause death to occur in the weeks after the initial insult:
When we talk about shock in trauma patients, what we are really referring to is this lethal triad of acidosis, coagulopathy and hypothermia. The best way to reduce this condition is to prevent it from happening in the first place. This is why we look immediately for the initial signs of shock:
Recall that a falling or low blood pressure is a very late sign. In fact, in the initial phases of shock, blood pressure may actually rise briefly. A French study looked at the causes of hypothermia in trauma patients. The researchers found that hypothermia occurred in 14% of the study population. While the severity of the injury was the primary cause, the temperature of the transport unit as well as the temperature of the fluid used during resuscitation also played a major part in cooling the patient's core temperature.2
Further analysis shows that while the ambient temperature of the environment plays a small part in hypothermia, having the clothes removed on scene is a significant factor.
What does this mean for EMS providers in the management of trauma patients? Consider the following tips:
Critically injured patients require the utmost of care in the initial resuscitation phase. EMS providers can promote better outcomes by keeping in mind the dangers of hypothermia in trauma patients. Simple interventions can go a long way in preventing such deadly heat loss.
1. Centers for Disease Control. "10 Leading Causes of Death by Age Group, United States – 2010." http://www.cdc.gov/injury/wisqars/pdf/10LCID_All_Deaths_By_Age_Group_2010-a.pdf. Accessed 12 March 2013.
2. Lapostolle, F et al. Risk factors for onset of hypothermia in trauma victims: The HypoTraum study. EPub. Critical Care. 2012 Jul 31;16(4):R142. http://ccforum.com/content/16/4/R142. Retrieved 12 March 2013.
3. Newgard CD, Schmicker RH, et al. Emergency medical services intervals and survival in trauma: assessment of the "golden hour" in a North American prospective cohort. Ann Emerg Med. 2010 Mar;55(3):235-246.e4.
4. Stockinger ZT, McSwain NE. Prehospital endotracheal intubation for trauma does not improve survival over bag-valve-mask ventilation. J Trauma 2004;56:531–536.
5. Gentilello LM, Cortes V, Moujaes S, et al. Continuous arteriovenous rewarming: experimental results and thermodynamic model simulation of treatment for hypothermia. J Trauma 1990; 30:1436-49.