To be cold or not to be cold?

[Kn.ght1]

Ok here is my first topic go easy

I have two questions.

The other day a fellow EMT and I were talking about trauma patients. I told him about the trauma triangle of death. Hypothermia, coagulopathy and acidosis. He mention that he read a article about hypothermia being a good thing for trauma patients. Does anyone know more about this? I've done some reading but no articles show hypothermia being good for trauma patients. Any thoughts on keeping our trauma patients warm or not?

In the process of looking for hypothermia in trauma I came across hypothermia therapy for MI. I've read a couple articles positive outcomes for randomized patients. Is there anything we can do as ems providers to start the HT process? Or be aware of when dealing with acute MI?

Kn.ght1

[paramedicmike]

Several prehospital systems nationwide and throughout the world have procedures in place to begin cooling in certain patients with certain conditions. As your reading has demonstrated, there are certain conditions (e.g. MI and CVA) in which cooling can be beneficial to the patient.

Did you ask him for the article that he read?

+1 for doing your research before asking questions here. You have no idea how important that is. You'd also be amazed at how few people actually do research before asking questions here.

[MariB]

My biggest concern with a major trauma would be shock. EMT level of course is keeping patient warm and supine with O2 as needed.

Maybe someone else here has heard more about it.

[chbare]

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.")

[croaker260]

I have been involved in our own theraputic hypothermia project at my agency, and we currently do it s/p cardiac arrest. I think its safe to say we are out of the "early adopter" phase and into a more mainstream acceptance of the curve for mild hypothermia s/p cardiac arrest.

That said I am unaware of hypothermia in multi -system trauma. As mentioned above; hypothermia is typically very bad in trauma, increasing mortality significantly. the only possible exceptions may be isolated closed head injury and isolated spinal cord injury, though this is still in the research and case example phase and far from common.

If you have anything different, I would be happy to hear about it.

[DwayneEMTP]

Intuitively I can't imagine a benefit to hypothermia in trauma patients, though can imagine deficits. I've also not seen or heard anything about this being beneficial.

I'm thinking that your buddy heard a rumor, or heard of the possible benefits for cardiac and stroke patients and got them confused....

[Kn.ght1]

I believe my friend was mistaken as well. I just wanted to see if there anything to it.

Also it helped me break the ice and put up a topic

thanks everyone!

Kn.ght1

[DwayneEMTP]

Good on you Kn.ght1...It's really good to have you.

And something about that avatar friggin' rocks!

[Arctickat]

You a transformers fan Dwayne?

[BushyFromOz]

Hey Kat

How do you guy go about preventing hypothermia in entrapped patients during the winter?