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Hypothermia is indeed a major concern in the trauma patient. Significant hypothermia (somewhere less than 35 C) in a trauma patient can be disastrous. Proteins in the body like many of our enzymes have a special shape known as conformation. This shape is in part responsible for how a protein works or performs it's specific job. Hypothermia may induce conformational changes resulting in a bleeding dysfunction broadly called a coagulopathy. This results in impaired ability to clot. This appears particularly pronounced in acidotic patients (not uncommon in hypovolemic shock). This creates somewhat of a dichotomy. Controlled hypothermia can decrease post arrest morbidity and mortality but can increase trauma morbidity and mortality. Therefore, it is important to be sure what kind of patient you are dealing with. Trauma versus post medical arrest. Also, hypothermia can be devastating in children but may also be helpful in paediatric patients who are post medical arrest. I'm not sure there is significant data at this point however. Hope that helps. (Bonus points for figuring out how many times I said "this.")

I'm positive the diagnosis was made AFTER the patient had a CT scan and labs done both of which we don't have the luxury of in the field. The first rule of medicine is "do no harm". You always rule out the diagnosis that is most life-threatening first and then work your way down the list. Yes, he had indicators of sepsis (or perforated bowel) and other possible diagnoses but the AAA diagnosis will kill the fastest especially if mistreated. Since AAA was high on the list of diagnoses with his high risk factors (liver failure), hypotension, distended RIGID abdomen (not sure how you could palpate anything with that kind of abdomen) and description of the pain "ripping him in half and through to his back" then you can't rule it out. You don't want to do anything that could make him bleed out faster. Since he remained A&O x 4 throughout, then not pouring fluids in or starting pressors was appropriate since he is obviously adjusted to low BP's and was still perfusing his brain. I have seen too many incidents of people dropping their BP significantly with narcotics to risk it with that level of hypotension (with Fentanyl as well as Morphine). It's harder to get back a code than to prevent one from happening. I am a huge advocate of pain relief and if you gave fluids with no real success and he remained alert then I would trial small doses of narcotics, however he probably only didn't tank his BP because of the fluid boluses given as well. You had no BP readings along with no peripheral pulses so I would have been even more cautious about giving narcotics. Once you rule out the AAA which couldn't be done until the ER, then it's appropriate to fluid resuscitate and add pressors and get his pain under control. Critical thinking is about keeping in mind all the most likely diagnoses and balancing the treatment so you don't make the patient worse by mistreating one possible diagnosis.

I got word yesterday. I passed my National. Im up for another 2 years. :-D

Ive recently received my rank as a texas certified EMT-I last week.