Post-traumatic hypothermia as a challenge for pre-hospital healthcare providers

Tomasz Kłosiewicz, Radosław Zalewski

Abstract


ABSTRACT

Hypothermia is widely described in available literature, starting from the reasons for its occurrence through treatment methods at various stages of health care, to its use in various therapies. It is a disease entity that can undoubtedly be a big challenge for pre-hospital healthcare providers, especially looking through the prism of available in-ambulance equipment for active and passive heating. Understanding the behavior of patients with hypothermia requires a thorough understanding of the mechanisms responsible for thermoregulation in our body. This paper contains an overview of available literature showing the causes, statistics of the occurrence of posttraumatic hypothermia, and the most effective ways to treat it. Emergency medical teams often respond to patients who may have several health and life-threatening conditions at once. People who have suffered injuries in the course of various events are often exposed to post-traumatic hypothermia. It is often masked by the symptoms of a hypovolemic shock. Providers who focus on the treatment of injuries should not ignore preventing hypothermia, as it can develop with any severe injury.

The aim of this paper is to discuss the mechanisms leading to post-traumatic hypothermia and to indicate the priorities of treatments. This awareness will help in recognizing posttraumatic hypothermia, and selection of the most effective methods of treatment.


Keywords


hypothermia; emergency medical service; ambulances; emergency treatment

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References


Guly H. History of occidental hypothermia. Resuscitation 2011;82(1):122-5. doi: 10.1016/j.resuscitation.2010.09.465.

Brown DJ, Brugger H, Boyd J, Paal P. Accidental hypothermia. N Engl J Med 2012;367(20):1930-8.

Darocha T, Kosiński S, Jarosz A, Sobczyk D, Gałązkowski R, Sanak T, et al. Zasady postępowania w wychłodzeniu – małopolski program pozaustrojowego leczenia hipotermii. Kardiol Pol 2015;73:789-94.

Truhlář A, Deakin C, Soar J, Khalifa G, Alfonzo A, Bierens J, et al. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015;95:148-201. doi: 10.1016/j.resuscitation.2015.07.017.

Gagge AP, Fobelets AP, Berglund LG. A standard predictive index of human response to the thermal environment. ASHRAE Trans 1986;92:709-31.

Sosnowski P, Mikrut K, Krauss H. Hypothermia – mechanism of action and pathophysiological changes in the human body. Postępy Hig Med Dośw 2015;69:69-79.

American College of Surgeons Committee in Trauma. Advanced Trauma Life Support for Doctors, Sudent Course Manual, 2008.

Ireland S, Endacott R, Cameron P, Fitzgerald M, Paul E. The incidence and significance of accidental hypothermia in major trauma – a prospective observational study. Resuscitation 2011;82(3):300-6. doi: 10.1016/j.resuscitation.2010.10.016.

Søreide K. Clinical and translational aspects of hypothermia in major trauma patients: from pathophysiology to prevention, prognosis and potential preservation. Injury 2014;45(4):647-54. doi: 10.1016/j.injury.2012.12.027.

Beilman GJ, Blondet JJ, Nelson TR, Nathens AB, Moore FA, Rhee P, et al. Early hypothermia in severely injured trauma patients is a significant risk factor for multiple organ dysfunction syndrome but not mortality. Ann Surg 2009;249(5):845-50. doi: 10.1097/SLA.0b013e3181a41f6f.

Gregory J, Flancbaum L, Townsend M, Cloutier C, Jonasson O. Incidence and timing of hypothermia in trauma patients undergoing operations. J Trauma 1991;31(6):795-800.

Szwamel K, Kurpas D. Analysis of the structure of medical services branch of the Hospital Emergency Ward with special reference to the benefits provided to patient with minor injuries. Family Med Primary Care Rev 2015;17(2):124-30.

Trentzsch H, Huber-Wagner S, Hildebrand F, Kanz KG, Faist E, Piltz S, et al. Hypothermia for prediction of death in severely injured blunt trauma patients. Shock 2012;37(2):131-9. doi: 10.1097/SHK.0b013e318245f6b2.

Waibel BH. Hypothermia in trauma patients: predicting the big chill. Crit Care 2012;16(5):155. doi: 10.1186/cc11473.

Kłosiewicz T. Pre-hospital spine immobilization in light of the most recent knowledge. Emerg Med Serv 2016;3(1):7-10.

Conway A. A review of the effects of sedation on thermoregulation: insights for the cardiac catheterization laboratory. J Perianesth Nurs 2016;31(3):226-36. doi: 10.1016/j.jopan.2014.07.016.

Harmsen AM, Giannakopoulos GF, Moerbeek PR, Jansma EP, Bonjer HJ, Bloemers FW. The influence of prehospital time on trauma patients outcome: a systematic review. Injury 2015;46(4):602-9. doi: 10.1016/j.injury.2015.01.008.

Balvers K, Van der Horst M, Graumans M, Boer C, Binnekade JM, Goslings JC, et al. Hypothermia as a predictor for mortality in trauma patients at admittance to the Intensive Care Unit. J Emerg Trauma Shock 2016;9(3):97-102. doi: 10.4103/0974-2700.185276.

Conway A. A review of the effects of sedation on thermoregulation: insights for the Cardiac Catheterization Laboratory. J Perianesth Nurs 2016;31(3):226-36. doi: 10.1016/j.jopan.2014.07.016.

Martin RS, Kilgo PD, Miller PR, Hoth JJ, Meredith JW, Chang MC. Injury-associated hypothermia: an analysis of the 2004 National Trauma Data Bank. Shock 2005;24(2):114-8.

Lapostolle F, Sebbah JL, Couvreur J, Koch FX, Savary D, Tazarourte K, et al. Risk factors for onset of hypothermia in trauma victims: the HypoTraum study. Crit Care 2012;16(4):R142. doi: 10.1186/cc11449.

Rotondo MF, Schwab CW, McGonigal MD, Phillips GR , Fruchterman TM, Kauder DR, et al. „Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 1993;35(3):375-82.

Mikhail J. The trauma triad of death: hypothermia, acidosis, and coagulopathy. AACN ClinIssues 1999;10(1):85-94.

Valeri CR, Feingiold H, Cassidy G, Ragno G, Khuri S, Altschule MD. Hypothermia-induced reversible platelet dysfunction. Ann Surg 1987;205(2):175-81.

Bukur M, Hadjibashi AA, Ley EJ, Malinoski D, Singer M, Barmparas G, et al. Impact of prehospital hypothermia on transfusion requirements and outcomes. J Trauma Acute Care Surg 2012;73(5):1195-201. doi: 10.1097/TA.0b013e31826fc7d9.

Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJ, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2010;81(10):1400-33. doi: 10.1016/j.resuscitation.2010.08.015.

Niven DJ, Gaudet JE, Laupland KB, Mrklas KJ, Roberts DJ, Stelfox HT. Accuracy of peripheral thermometers for estimating temperature: a systematic review and meta-analysis. Ann Intern Med 2015;163(10):768-77. doi: 10.7326/M15-1150.

Bijur PE, Shah PD, Esses D. Temperature measurement in the adult emergency department: oral, tympanic membrane and temporal artery temperatures versus rectal temperature. Emerg Med J 2016;33(12):843-7. doi: 10.1136/emermed-2015-205122.

Zaborowski M, Kopański Z, Leszczyński P. Ergonomics at work in the ambulance – the opinion of paramedics. J Public Health Nursing Medical Res 2015;3:27-32.

Henriksson O, Lundgren PJ, Kuklane K, Holmér I, Giesbrecht GG, Naredi P, et al. Protection against cold in prehospital care: wet clothing removal or addition of a vapor barrier. Wilderness Environ Med 2015;26(1):11-20. doi: 10.1016/j.wem.2014.07.001.

Henriksson O, Lundgren P, Kuklane K, Holmér I, Naredi P, Bjornstig U. Protection against cold in prehospital care: evaporative heat loss reduction by wet clothing removal or the addition of a vapor barrier – a thermal manikin study. Prehosp Disaster Med 2012;27(1):53-8. doi: 10.1017/S1049023X12000210.

Durrer B, Brugger H, Syme D. The medical on-site treatment of hypothermia: ICAR-MEDCOM recommendation. High Alt Med Biol 2003;4(1):99-103. doi: 10.1089/152702903321489031.

Thomassen Ø, Færevik H, Østerås Ø, Sunde GA, Zakariassen E, Sandsund M, et al. Comparison of three different prehospital wrapping methods for preventing hypothermia – a crossover study in humans. Scand J Trauma Resusc Emerg Med 2011;19:41. doi: 10.1186/1757-7241-19-41.

Henriksson O, Lundgren JP, Kuklane K, Holmér I, Bjornstig U. Protection against cold in prehospital care-thermal insulation properties of blankets and rescue bags in different wind conditions. Prehosp Disaster Med 2009;24(5):408-15.

Haverkamp FJC, Giesbrecht GG, Tan EC. The prehospital management of hypothermia – an up-to-date overview. Injury 2017;49(2):149-64. doi: 10.1016/j.injury.2017.11.001.

Lundgren P, Henriksson O, Naredi P, Björnstig U. The effect of active warming in prehospital trauma care during road and air ambulance transportation – a clinical randomized trial. Scand J Trauma Resusc Emerg Med 2011;19:59. doi: 10.1186/1757-7241-19-59.

Karlsen A, Thomassen Ø, Vikenes B, Brattebø G. Equipment to prevent, diagnose, and treat hypothermia: a survey of Norwegian pre-hospital services. Scand J Trauma Resusc Emerg Med 2013;21:63. doi: 10.1186/1757-7241-21-63.Collins N, Daly S, Johnson P, Smith G. Pre-hospital use of intravenous in-line fluid warmers. Australasian J Paramedicine 2015;12(2):1-5.

Kosiński S, Sanak T. Termoizolacja. In: Kosiński S, Darocha T, Sadowski J, Drwił R, editors. Hipotermia, kliniczne aspekty wychłodzenia organizmu. Kraków: Wydawnictwo Uniwersytetu Jagiellońskiego; 2016.

Weinberg AD. The role of inhalation rewarming in the early management of hypothermia. Resuscitation 1998;36(2):101-4.

Goheen MS, Ducharme MB, Kenny GP, Johnston CE, Frim J, Bristow GK, et al. Efficacy of forced-air and inhalation rewarming by using a human model for severe hypothermia. J Appl Physiol (1985) 1997;83(5):1635-40.

Hayward JS, Steinman AM. Accidental hypothermia: an experimental study of inhalation rewarming. Aviat Space Environ Med 1975;46(10):1236-40.




DOI: https://doi.org/10.21164/pomjlifesci.484

Copyright (c) 2018 Tomasz Kłosiewicz, Radosław Zalewski

License URL: https://creativecommons.org/licenses/by-nc-nd/3.0/pl/