# Warmed IV fluids in hypothermic patients



## Flyhi (Mar 22, 2012)

Hi All,

Just looking for any good articles anyone may know of for the use of warmed IV fluids for rewarming of hypothermic Pt. Particular a Pt we take from the sea where we will have a long flight back to the nearest hospital.  All advice is very welcomed


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## DPM (Mar 22, 2012)

Not an article but some advice for you: 

Tape up 2 /4 / as many coils of your IV tubing as you can, and then tape hot pack on either side of them. It heats the fluid as it travels through the coils, much more efficient than trying to hear the entire bag at once.


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## Flyhi (Mar 22, 2012)

Nice tip. Thanks a million. Still looking for protocols, guidelines etc if any of you use this rewarming method. Thanks again DPM


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## DPM (Mar 22, 2012)

http://www.sccgov.org/portal/site/e...0VgnVCM10000048dc4a92____&cpsextcurrchannel=1

That's not my county, but it's set up well and easy to navigate. Just don't forgot that IV fluids are room / ambulance temperature, so they're already going to be colder than your PT. A lot of people can handle that, but if you're in shock or taking on a lot of fluid, then you're going to be cooling them down rapidly. Likewise, if you're lying on a back board with most of your clothes chopped off, at night.... I think you can see what I'm getting at.

People get cold fast, and it doesn't take much to warm the fluids. Granted, you might not have time, but it won't hurt if you can do it.


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## crazycajun (Mar 22, 2012)

We actually use fluid warmers that are on 24/7


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## NYMedic828 (Mar 22, 2012)

DPM said:


> Not an article but some advice for you:
> 
> Tape up 2 /4 / as many coils of your IV tubing as you can, and then tape hot pack on either side of them. It heats the fluid as it travels through the coils, much more efficient than trying to hear the entire bag at once.



Thats genius lol. 

In the cold months we may leave a liter bag on the floor in front of the heater vent or on the defroster up front to keep warm.


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## Flyhi (Mar 22, 2012)

Good link. Thanks



DPM said:


> http://www.sccgov.org/portal/site/e...0VgnVCM10000048dc4a92____&cpsextcurrchannel=1
> 
> That's not my county, but it's set up well and easy to navigate. Just don't forgot that IV fluids are room / ambulance temperature, so they're already going to be colder than your PT. A lot of people can handle that, but if you're in shock or taking on a lot of fluid, then you're going to be cooling them down rapidly. Likewise, if you're lying on a back board with most of your clothes chopped off, at night.... I think you can see what I'm getting at.
> 
> People get cold fast, and it doesn't take much to warm the fluids. Granted, you might not have time, but it won't hurt if you can do it.


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## Flyhi (Mar 22, 2012)

Anyone got thoughts on warming pack v warmed fluids?? Anyone out there actually use warmed fluids ?? Looking at this for a case study for our SAR paramedics as we often pull a survivor from the sea. They are hypothermic and we could be flying 1 - 2 hrs back to land. I am trying to Present an evidence based argument to allow us to use IV fluids to aid rewarming. It's hard to get some good reliable articles or advice from people who actually use it. Hence my turning it open to all you guys & gals:huh:


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## DPM (Mar 22, 2012)

I can't find a protocol, but there are a few studies out there, and hypothermia.org/ is a good resource.

Good luck, I'm interested to see what you find.


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## jwk (Mar 22, 2012)

Sorry to burst your bubble, but it is physically impossible to WARM a patient with IV fluids.  Warmed fluids can help prevent further drops in temperature, but the volumes and flow rates required to actually raise a patient's temperature make it impossible.  If you want to warm a hypothermic patient, the single best thing you can do is forced hot air warming - Bair Hugger, Level 1, etc.


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## Mountain Res-Q (Mar 22, 2012)

jwk said:


> Sorry to burst your bubble, but it is physically impossible to WARM a patient with IV fluids.  Warmed fluids can help prevent further drops in temperature, but the volumes and flow rates required to actually raise a patient's temperature make it impossible.  If you want to warm a hypothermic patient, the single best thing you can do is forced hot air warming - Bair Hugger, Level 1, etc.



Thank you!!!  And, warm iv only helps the pt. fight hypothermia and maintain their own core temp.  You are not reversing hypothermia.

Best analogy I have heard is: take 100 cups of 90 degree water.  Add a single cup of 120 degree water to the total.  The temp of the total is only going to be ~90.5 degrees.  Mathmatically, it is impossible to add enough warm fluids to artificially raise core temp.  I get into this argument all the time for wilderness hypothermia.  Hot chocolate and hand warmers can not reverse hypothermia!  Not to say that the calories and hydration does not help, but stop believing that any real treatment for hypothermia exists prehospital, especially in a remote setting.  What they taught in class was taught simply because it is all that can be done, not because it will treat hypothermia.


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## crazycajun (Mar 22, 2012)

Mountain Res-Q said:


> but stop believing that any real treatment for hypothermia exists prehospital.



This is not entirely true. Blanket warmers along with hot packs and WARM IV fluids most certainly will raise core temp. We carry all mentioned on our unit. Our cabinets are heated, our warmers are on 24/7 and our blankets are toasty. I know first hand that we have the capability to raise core temp as much as 19 degrees.


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## Mountain Res-Q (Mar 22, 2012)

crazycajun said:


> This is not entirely true. Blanket warmers along with hot packs and WARM IV fluids most certainly will raise core temp. We carry all mentioned on our unit. Our cabinets are heated, our warmers are on 24/7 and our blankets are toasty. I know first hand that we have the capability to raise core temp as much as 19 degrees.



I'd like to see numbers and studies.  I love hypothermia and have read every study I could find.  I have attended numerous lectures provided by an Expedition Doctor and FACEP at the receiving trauma center for Yosemite.  The numbers he has presented showed that the best they are capable of in a controled hospital with all the technology available is a 2 degree raise per hour.  In his lecture he lays out the math and chemestry involved in raising core temps with all the comparably limited prehospital warming equipment; best case: if the body has stopped fighting hypothermia, everything in th most state of the art ambulance in America might hold the temerature.  In an outdoor/wilderness setting, you are fighting a losing battle; do what you can, but evac NOW!  If they are fighting it, then you supportive care will assist them in raising their own temp.

Of course, as this doc says, these are his opinions based on 35 years of experience as a Paramedic, Expedition Doctor, Yosemite SAR Doctor, and Trauma Doc.  I am willing to believe that anything is possible; not the norm, but possible.  Having dived into these wilderness hypothermia case studies, being able to raise a core temp 19 is unrealistic for me...  (mathmatically, cant see that happening prehospital - that would mean a core temp in the 70's being raised artificially in the short prehospital time... hard time swollowing that)... not that I wont try, but would divert focus away from warm fluids and heat packs first, and towards creating a warm environment / warm air...  warm water lavage, heat lamps, humidified forced O2... not realistic outside the hospital setting for me, but things that you want to provide to a truely severly hypothermic patient... hence my statement that you need to transport/evac as the really meaningful treatments are unlikely (but possible on a limited bases) to be found prehospital.


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## DPM (Mar 22, 2012)

Interesting debate, I'd love to read the studies.

I went down with hypothermia a few years ago when I was in the army. Fell through some ice. The water wasn't deep but it was cold! The lads ended up doubling up 2 sleeping bags and then they took it in turns double bagging it with me. Worked well, and about an hour of that, some dry clothes and copious tea and I was good to go!


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## jwk (Mar 23, 2012)

crazycajun said:


> This is not entirely true. Blanket warmers along with hot packs and WARM IV fluids most certainly will raise core temp. We carry all mentioned on our unit. Our cabinets are heated, our warmers are on 24/7 and our blankets are toasty. I know first hand that we have the capability to raise core temp as much as 19 degrees.



Cajun, this is pretty simply physics.  You're wrong, and, you're also talking about two entirely different ways of rewarming.  You can't warm someone that is that hypothermic with warm blankets and IV fluid.

From a physics standpoint,  Mountain Res-Q is exactly right.  It's not an opinion - it's scientific fact. 

Specific heat is the quantity of heat required to raise the temperature of 1g of the substance by 1degC.  The human body for all practical purposes is a big bag of water.  It takes 1 calorie of energy to raise the temperature of 1 gram of water 1 degree Celsius.  A liter (1kg) of saline dumped into a 70kg patient just isn't going to do anything, and you can't flood the patient with IV fluid to warm them up.  Now - you certainly SHOULD give warm IV fluid, because giving room temp (or lower) fluid to someone who is already hypothermic doesn't exactly help them.  But also remember - room temp fluid is 30degF colder than normal body temp.  You can only give warmed IV fluids a few degrees warmer than normal body temp or you'll start cooking RBC's.

Warm blankets can help - but you have to keep changing the blankets because they cool off quickly.  You have to keep supplying heat to warm someone - that's why forced-air warming systems are the gold standard.


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## Mountain Res-Q (Mar 23, 2012)

jwk said:


> Cajun, this is pretty simply physics.  You're wrong, and, you're also talking about two entirely different ways of rewarming.  You can't warm someone that is that hypothermic with warm blankets and IV fluid.
> 
> From a physics standpoint,  Mountain Res-Q is exactly right.  It's not an opinion - it's scientific fact.
> 
> ...



As I have said before, I am willing to entertain any possibility provided I see the science to back it up.  Everything I have ever researched in in complete agreement with your view.  While no one is saying "Don't do it", the reality based on simple science is that for a severely hypothermia patient you NEED a hospital.  Once they have stopped fighting it, call the heat packs, IVs, and naked body on naked body in the world is unlikely to matter.  Those tricks only have a chance of working when thy are SUPPORTING the patients physiological attempts to rewarm themselves.

On a side note, people who rave about hardwarmers and footwarmers need to do some basic math and chemistry.  When placed against an artery, sure they may help, but as handwarmers and footwarmers, they are only psychologically beneficial and may actually be physically harmful.  First, understand that the amount of heat produced by those things CANNOT raise your core temp.  The math (which is of memory only) is over 1,000 of them to raise your core temp by 1 degree.  They can not reverse hypothermia; your IV plan is a better plan combined with handwarmers at the artery, warm environment, warm air, etc.  In fact, for the mildly hypothermia they may hurt you; consider that the natural response to hypothermia is for the peripheral vessels to constrict in order to keep body heat at the core.  When you fool your hands and feet into thinking it is warmer than it is, I have seen some speculation that supposes that while artificially raising the temperature of your fingers by a degree or two, you may be lowering the core temp by telling the body it is okay to send warm blood away from the core.  Something to think about.

As stated, the best course is go and try everything available, but be realistic in the physics of available hospitable treatments and don't be mislead by the "hypothermia treatment" rhetoric preached in most classes.  In my world, hypothermia is as important as the ABC's.

Oh, and thanks for claiming that I was "exactly right".  It is not often that people state that... ^_^


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## Aidey (Mar 23, 2012)

jwk said:


> Specific heat is the quantity of heat required to raise the temperature of 1g of the substance by 1degC.  The human body for all practical purposes is a big bag of water.  It takes 1 calorie of energy to raise the temperature of 1 gram of water 1 degree Celsius.  A liter (1kg) of saline dumped into a 70kg patient just isn't going to do anything, and you can't flood the patient with IV fluid to warm them up.



And this folks is why the metric system is awesome. 

/hijack


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