Do We Make Trauma Patients Worse............

[romneyfor2012]

While thinking about the trauma patient call, I remembered this old topic about 66% of trauma patients arriving to the ER in a hypothermic state (not due to intentional hypothermia). I searched for it as a topic and did not find it, so if it has been discussed already I apologize. But think about it:

We cut their clothes off, dump a bunch of cold IV fluid in them (at best your fluid is the same temperature as the ambient air in the truck, which is probably 60-70 degrees (probably worse in winter) after we lay them on a back board that is stored in an outside compartment (again could be really cold in winter months).

Do you always cover them with a good blanket, or a thin sheet ?

[DFIB]

The average temperature where I work is above 90 degrees. I usually only cover burn, shock and spinal injury patients that are suspect of spinal cord injury.

I have often wondered about the temperature of IV fluids at the time of infusion as we can drastically change a body temperature with fluids. We pay close attention to fluid temperature in environmental emergencies and patients with high fever. We do not measure the temperature before infusion but simply judge the temperature by touch. If the patient is too hot we try to make sure the fluids are cool to the touch and warm if the patient is too cold.

Without having any hard data on fluid temperature and hypothermia it would be difficult ot be accurate but I would be inclined to believe that we do actively and inadvertently contribute to the "cooling" of patients. In cooler temperatures I have observed that patients get a blanket when they manifest that they feel cold.

It is a great observation and will influence my thinking and treatment in the future.

[Just Plain Ruff]

While thinking about the trauma patient call, I remembered this old topic about 66% of trauma patients arriving to the ER in a hypothermic state (not due to intentional hypothermia). I searched for it as a topic and did not find it, so if it has been discussed already I apologize. But think about it:

We cut their clothes off, dump a bunch of cold IV fluid in them (at best your fluid is the same temperature as the ambient air in the truck, which is probably 60-70 degrees (probably worse in winter) after we lay them on a back board that is stored in an outside compartment (again could be really cold in winter months).

Do you always cover them with a good blanket, or a thin sheet ?

In answer to your topic which is a question - undeniably we make them worse sometimes. But sometimes we make them better.

I always have covered my trauma patients with a sheet after I've done the exam and splinted obvious fractures and covered open wounds. I'm sorry but patient dignity did not cease when they get injured?

It takes minimal time to cover a patient. nuff said

[DFIB]

In answer to your topic which is a question - undeniably we make them worse sometimes. But sometimes we make them better.

I always have covered my trauma patients with a sheet after I've done the exam and splinted obvious fractures and covered open wounds. I'm sorry but patient dignity did not cease when they get injured?

It takes minimal time to cover a patient. nuff said

I agree that patient dignity is very important but the question stands; do you cover them to prevent heat loss or simply to protect their modesty?

I am aware that the result is the similar in varying degrees but also think that the difference between a sheet for modesty and a blanket for temperature control are different both in intent and result

.

[spenac]

We keep heated fluid and we use blankets to help keep them warm. We also have heat in patient compartment. No time to look for it but hypothermia was shown as good thing in some trauma cases.

[DwayneEMTP]

I've never hesitated to strip a trauma patient in the cold and snow if I thought that I needed to do so immediately, but have also always covered them with a blanket after. In Colorado I got a bunch of shit because I'd warm my fluid in the pts microwave before transport if I thought that they needed the help. (Did you know that 'everyone' knows that saline when nuked in a soft bag causes toxins to leach out of the bag and makes the fluid toxic too? I didn't, and continue not to know this, but am constantly informed by medics that it's 'obvious' and 'everyone' knows it. Just sayin'...)

Though I've not always taken relative hypothermia as seriously as I should have. For instance at the CAP lab Wendy and I were in the same sim baby scenario that was run by another medic. It was a blue baby found drowned. She had much to add, but one thing she wouldn't give up on is trying to cover the baby with a friggin' blanket! I love Wendy, but I was gonna choke her to death with that God damned blanket...though it was clear from the monitor that the baby's tempt was, not sure, around 95-96F, it just wasn't a priority for me.

Anyway, she finally fought her way through all of the macho medics and got the baby covered, it's temp came up on the monitor, and another sim life was saved.

When the ER doc/instructor for the medical school came back into the room, they watch everything on remote cams, he said that it wasn't a bad resusc attempt but that we should have covered the baby much sooner as the patients body temperature will always play some part, and often will be THE difference between success and failure of attempted interventions.

Friggin' women...think they know everything...and it turns out, sometimes they do. But you could have knocked me over with a feather. I would have bet much that the few degrees of core temp would have made little if any difference at all. I mean, C'mon! Surely I lose more than that when I go swimming in cold water! I was truly shocked...

I refuse to ever use a backboard, except on really hinky patients where it will end up sliding around and being a hindrence, without a quartered blanket on it. I just see no sense in it. No sense in the board for sure, but not to put a blanket on it makes no sense to me at all.

Great question Rom, as always. Thanks man.

Dwayne

[Just Plain Ruff]

But dwayne, on the cold baby, babies tolerate heat loss much worse than we fat adults. I would have covered the baby up as well but left the chest exposed for CPR. But why not put the blanket on the legs and a small stocking cap on the head. Not like you are doing much to the legs or scalp unless you are doing a scalp vein access or IO on the legs, then you can cover around those areas.

And Romney, answer to your question, I cover them up for dignity as well as warming. How many cardiac arrests or bad trauma where we don't cover them up and they arrive at the ER with a low temp?

So yes I cover them for both reasons, many more times they are covered because they feel cold to me so why not warm em.

[DwayneEMTP]

...But why not put the blanket on the legs and a small stocking cap on the head.

Ignorance only. I wasn't making the case not to do it, but explaining how shocked I was that a few degrees can make such a big difference in pt care, even a ped. I will certainly consider these issues differently in the future.

Dwayne

[DFIB]

I've never hesitated to strip a trauma patient in the cold and snow if I thought that I needed to do so immediately, but have also always covered them with a blanket after. In Colorado I got a bunch of shit because I'd warm my fluid in the pts microwave before transport if I thought that they needed the help. (Did you know that 'everyone' knows that saline when nuked in a soft bag causes toxins to leach out of the bag and makes the fluid toxic too? I didn't, and continue not to know this, but am constantly informed by medics that it's 'obvious' and 'everyone' knows it. Just sayin'...)

There have been suppositions and rumors about the safety of microwaving food because it heats by molecular excitement causing friction on a molecular level. Although the idea of microwaves changing the molecular composition of a compound or altering the DNA of organic compounds has been knocked around for some time now, I have not found any scholarly studies that prove this theory.

I find it interesting that folks would believe that heating IV fluids would cause the container to leech toxins into the fluid. If this were true wouldn’t toxins be leeched without the microwave heating? Are IV fluids always stored in a climate controlled environment as to avoid Brownian or other molecular movements?

Here is a simplistic link that shows some of the reasoning behind this idea.

http://www.snopes.com/science/microwave/plants.asp

I think I would like to see cbare chime in on this subject.

[romneyfor2012]

Just went and checked, truck in the heated bay, bay thermostat set on 65, truck has been in about an hour, iv fluids 68 degrees. Yikes! When its real cold I do keep two bags on dash next to defrost vents or hang bag in front of rear heater