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

[DFIB]

Chris,

Dude! Wow! When I asked for your thoughts I never thought you would invest the time and effort into an explanation like this but I am appreciative that you did. Your information is precise, accurate and explained in the most practical of ways. You have just climbed to the top of my Awesomeness Scale! I already knew you were the smartest guy in the room but once again you have set the bar high.

Thanks for raising the bar once again and your willingness to share with us all.

[DwayneEMTP]

Holy shit Chris, how cool was that??

I almost didn't watch it as I'd assumed that it was something you found online but figured that if you posted it that it was most likely worth watching...and it was.

And, for the record, I heat my fluids to precisely lukewarm and shake the hell out of them before delivery....It keeps the math easy as lukewarm is exactly the same temp in either F or C.

Thanks for taking the time to explain that!!

Dwayne

[Vorenus]

I almost didn't watch it as I'd assumed that it was something you found online but figured that if you posted it that it was most likely worth watching...and it was.

Same here. Watched it only after DFIB`s comment.

Just wow!

You`re amazing. I`d wish you would have been one of my teachers back in Para school! Actually - do you offer private sessions...?!

Edited December 22, 2011 by Vorenus

[island emt]

Coming from a place where we deal with hypothermia 12 months of the year due to cold ocean water surrounding the islands. we always use a space blanket and then cover with cotton blanket over that. We have a nice little insulated 12 volt fluid warmer bag in the truck that keeps fluids at just a tad over body temp. Yes you do have to cycle them through, but I don't want to put the pt's into shock while I'm treating them. We also have a 12 volt "electric bunk warmer blanket for when it's really winter and frigid . Kept in a cabinet inside the truck. They can be found at truck stops or online.

Our bus has 12 volt outlets all over the box intentionally.

[Chief1C]

We started using ReadyHeat II, 12 Panel self-warming blankets for wilderness rescues over a year ago. We used linen packages from like Sears, with the clear plastic and zipper to make "Hypothermia Packs". Just quick grab of stuff we typically use, but more than will fit in our SAR medical bag. You can also put IV bags in mylar sheets; and wrap them up with the ReadyHeat; and by the time you need them, they're warm.

http://www.techtradellc.com/ready_heat_II.shtml

[paramedicmike]

That was awesome, Chris. Thanks for putting that together!

To the original question, all patient's get appropriately exposed. Then, upon completion of the assessment, the patient's are covered in a manner appropriate to ambient temperature. Follow up and continuing assessment will see re-exposure and recovering as necessary. In the summer, the a/c in the back of the ambulance is always on. In the winter, the heat in the back of the ambulance is always blasting. Fluids are in a warmer set for between 100 and 104 degrees Fahrenheit.

Oddly enough, I believe I remember reading from the manufacturer of the saline bags that if kept in a warmer bags should be rotated out every two weeks if not used. Why? Chemicals leaching into the fluid from the plastic bag. That being said, how many of us actually have IV bags that sit for two weeks in the warmer? We sure don't.

Another thing I remember reading with the paperwork for my microwave (yes...I read the instructions that come with appliances) that when heating water in the microwave you can't control how hot you make it as Chris mentioned, but you also get inconsistent heating with some areas getting hotter than other areas. Dwayne addressed this when he mentioned he shakes the bags before hooking them up. But I don't know that I want to give anything that I've just heated if I can't tell to what temperature it's been heated.

Good question and excellent discussion.

[romneyfor2012]

Well all of us should have a thermometer to measure fever, so u should be able to reasonably measure the temp of the bag

[mobey]

Well all of us should have a thermometer to measure fever, so u should be able to reasonably measure the temp of the bag

True for an oral or rectal thermometer.

But would a tempatic/temporal be accurate?

[DwayneEMTP]

In a well shaken, comfortably lukewarm bag of saline, does it matter if it's body temp, 5F above, or 15F above body temp in a truly or relatively hypothermic patient?

I've never measured the temp and haven't noticed any side effects other than the patient appearing and reporting feeling warmer. Though, having nuked a few bottles of milk in my day I've also been pretty obsessed with making sure that it's well mixed and rechecked before delivery.

A few degrees to cold seemed intuitively obvious as unimportant, and I screwed the pooch on that, so am wondering if I'm simply screwing a different pooch with warmed fluids.

Dwayne

[DFIB]

In a well shaken, comfortably lukewarm bag of saline, does it matter if it's body temp, 5F above, or 15F above body temp in a truly or relatively hypothermic patient?

I've never measured the temp and haven't noticed any side effects other than the patient appearing and reporting feeling warmer. Though, having nuked a few bottles of milk in my day I've also been pretty obsessed with making sure that it's well mixed and rechecked before delivery.

A few degrees to cold seemed intuitively obvious as unimportant, and I screwed the pooch on that, so am wondering if I'm simply screwing a different pooch with warmed fluids.

Dwayne

I think not. Considering that your hands will be a little cold the bottle temp is probably just right.