If they are going to be dead.....They should be WARM and dead!

Tom Perroni

Tom Perroni

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Strong links between hypothermia, coagulopathy and acidosis have been demonstrated by data from numerous publications. The hypothermia point, as previously determined, is a core temperature below 35C (90f) secondary to hemorrhage or trauma. Consistently, in study after study, survival rates have been shown to be dramatically higher in multi-system trauma patients who are normothermic when compared with a patient who is hypothermic.

In a recent article Allen, et al discuss the prevention of hypothermia by comparing common devices in Volume 69 of the Journal of Trauma (July 2010). The authors begin by illuminating some of the significant past works that revealed the deadly implications of hypothermia like Eastridge, et al who demonstrated the correlation between hypothermia and massive transfusions in trauma patients. They also discuss Arthurs, et al one-year retrospective analysis of trauma patients at a Combat Support Hospital in Iraq where the mortality rate for incoming personnel with a Glasgow Comma Scale of <8 and a temperature of 33C or less was 100% (that was: one-hundred-percent).

What are your thoughts on this topic?

This info came from the Coalition for Tactical Medicine were I am a member.


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Tom Perroni
Doc "Gwedo"

"Trust me, I'm a medic"

The “State of the Art” in medicine is constantly changing –unlearn outdated medical training @ CCJA.
 
I believe the saying "warm and dead" has to do with environmentally induced hypothermia where there is a reduction in cell metabolism thus preserving the tissue which allows for better resuscitation outcomes.

But if you think about it, it would make sense that a trauma patient who is hypothermic for no apparent reason would have higher mortality than those who aren't
 
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Trauma patients (really most critically ill patients), as a rule, are hypothermic until proven otherwise. Blankets should be provided no matter what the outside temp. Strip them, then cover them back up with multilple blankets.
 
I like my trauma and most other critically ill patients to include burns to have blankets. It helps to prevent one more thing I have to manage.
 
Tom Perroni said:
The authors begin by illuminating some of the significant past works that revealed the deadly implications of hypothermia like Eastridge, et al who demonstrated the correlation between hypothermia and massive transfusions in trauma patients.
Click to expand...

I'm not sure what is to discuss here. It's well known that clotting factors don't work well in low temperatures. The correlation between hypothermia and the need for massive transfusion simply comes from trauma patients bleeding more due to their inability to clot.

The better discussion is why are some medics still shoving 12G needles in trauma patients and dumping a few bags of saline in before making any attempt to 1) control bleeding or 2) keep these people warm.

Another thing to discuss is how many people have protocols and equipment to use tourniquets and the quick clot stuff that the military uses. The military are the masters of treating trauma patients and have shown great success with both tourniquets and quick clot. Why are we, as civilians, so slow to pick up these large advancements in trauma care?

PS. I wonder how many trauma patients we (all EMS we) have killed by flooding them with room temperature saline (get the triple threat of increased pressure behind clots to break them off, the anemia caused by the displacement of blood with saline, and the coagulopathy caused by decreasing the body temperature with room temp saline)?
 
I am glad we are discussing the lethal triad and the fact the I am not the only one trying to keep these pt's warm. It burns my *** to have a naked trauma pt. and no blankets on them / my partner always forgets to get blankets from the E.D. In P.A., there are S.O.P.'s (protocols) that allow for the usage of T/Q's and quick clot to control life threatening hemmorage. It is becoming widly accepted through my county at least for the adoption of T/Q's and we (my squad) uses both SOFT-Ts and Quick clot tea bags (switching to combat guage soon).

325.
 
sir.shocksalot said:
I'm not sure what is to discuss here. It's well known that clotting factors don't work well in low temperatures. The correlation between hypothermia and the need for massive transfusion simply comes from trauma patients bleeding more due to their inability to clot.

The better discussion is why are some medics still shoving 12G needles in trauma patients and dumping a few bags of saline in before making any attempt to 1) control bleeding or 2) keep these people warm.

Another thing to discuss is how many people have protocols and equipment to use tourniquets and the quick clot stuff that the military uses. The military are the masters of treating trauma patients and have shown great success with both tourniquets and quick clot. Why are we, as civilians, so slow to pick up these large advancements in trauma care?

PS. I wonder how many trauma patients we (all EMS we) have killed by flooding them with room temperature saline (get the triple threat of increased pressure behind clots to break them off, the anemia caused by the displacement of blood with saline, and the coagulopathy caused by decreasing the body temperature with room temp saline)?
Click to expand...



I guess the better question is ....if it's so well known that clotting factors don't work well in low temperatures. Then WHY are civilian EMS providers still doing it?

I am very fortunate at CCJA we teach Military as well as civilian Fire/EMS so I get to see both sides. The Military is light years ahead of the Trauma game, I agree with you 100%

Also note that in order for "COMBAT GUAZE" to work you must be properly trained in how to pack a wound.

The MILLION DOLLAR QUESTION...How do we get everyone on the same page?

__________________
Tom Perroni
Doc "Gwedo"

"Trust me, I'm a medic"

The :censored::censored::censored:8220;State of the Art:censored::censored::censored:8221; in medicine is constantly changing :censored::censored::censored:8211;unlearn outdated medical training @ CCJA.
 
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Tom Perroni said:
I guess the better question is ....if it's so well known that clotting factors don't work well in low temperatures. Then WHY are civilian EMS providers still doing it?

I am very fortunate at CCJA we teach Military as well as civilian Fire/EMS so I get to see both sides. The Military is light years ahead of the Trauma game, I agree with you 100%

Also note that in order for "COMBAT GUAZE" to work you must be properly trained in how to pack a wound.

The MILLION DOLLAR QUESTION...How do we get everyone on the same page?

__________________
Tom Perroni
Doc "Gwedo"

"Trust me, I'm a medic"

The :censored::censored::censored:8220;State of the Art:censored::censored::censored:8221; in medicine is constantly changing :censored::censored::censored:8211;unlearn outdated medical training @ CCJA.
Click to expand...



I agree with the packing the combat guaze and packing the wound. We are teaching that in accordance with S.O.P.'s during the I.T.L.S. classes we provide for the county.

325.
 
Hypothermia is a massive occult issue in all emergency patients whether medical or trauma, whether self-presenting or brought in by EMS. We undress these people, give them fluid which is nearly 20*C colder than body temperature, we give them O2 that comes out of a cylinder below freezing and we leave them in draughty corridors or triage bays for ages.

IMHO, we should be actively warming these patients - warming blankets, fluid warmers - or at least giving them all proper heat preservation - bubble wrap or foil, warmed fluids - but nobody's going to pay for that because it doesn't kill quite enough people.
 
In this area, turniquets are making a come back. It has been common practice here for awhile that if you ARE going to give fluid to a traumatic hypovolemic, then it is only to get the systolic pressure close to 90. That being said, out Tactical team carriers quick clot and packs wounds, but I do not know of any EMS services that do. Turniquets with quick clot and properly dressed bandaged go along way when combined with warming the patient. Or should I say keeping their temp Normal.
 
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