Normothermic Fluid Administration

[abckidsmom]

Even if we are not making our patients "really cold", just by dropping their core temperature a little bits means that they are working very hard to stay warm.
Core temp decreased by 1.0°C results in an:
- increase in plasma noradrenaline by 230%
- increase in plasma adrenaline by 68%
- increase in CO by 23%
- increase in HR by 16%
We know that by giving fluid that is less than body temperature we are "trying" to drop their core temperature!

Interesting. Do you have a source for those numbers?

 

[Hebl]

Literature source

I will have a look through the large number of articles I have on the subject and get back to you - it will be there somewhere !

 

[Hebl]

Reference source

The information I quoted regarding the effects of hypothermia are found in the following article:
Clinical Science (2002) 102, 119-125 - S.M. Frank, C.G. Cattaneo - Threshold for adrenomedullary activation and increased cardiac work during mild core hypothermia.
It shows just how hard the body needs to work to maintain homeostasis when the core temperature drops 1C.

 

[Melclin]

We have heating lockers for warm fluids but they aren't used much. We usually just wrap them and crank the heater, monitoring their temp closely.

And thanks for that reference. I'm ganna hop on the warmed fluids a bit more I think.

 

[Hebl]

Warmed fluids

I think administering fluids warmed to normal body temperature is going to become normal practice in pre-hospital care in the future. This is one area of treatment that lacks any consistency. We use the HEBL Fluid Warmer with great success.

 

[Melclin]

Hebl warmers? What an exciting new idea? How do I blindly purchase one of these Hebl warmers of which you speak?

 

[MrBrown]

Hebl warmers? What an exciting new idea? How do I blindly purchase one of these Hebl warmers of which you speak?

Um, this bloke makes it sound like the MAS have them already?

Perhaps check out in the garage in that large white vehicle?

 

[mikie]

Interesting Claims...

So you're saying warm fluid does all of this?

From the source:

• Prevent the “Triad of Death” in trauma patients -Hypothermia, Acidosis and Coagulopathy.

• Improved patient comfort

• Reduced metabolic workload of “injured and sick” patients

• Improve Oxygen availability

• Decrease infection rates, both wound and intubation related pneumonia

• Reduce Renal complications - cold diuresis and tubular necrosis

• Reduce myocardial ischaemia and arrhythmias

• Prevent Hyperglycaemia

• Reduce time spent in hospital = reduce associated costs

• Reduce mortality and morbidity rates

Source

 

[MrBrown]

So you're saying warm fluid does all of this?

From the source:

Source

All sounds quite ambitious if you ask Brown given that these blokes do not actually cite any sources legitimate originale meidicono ....

 

[Hebl]

Normothermic Fluid references

For those people that are unsure about all this normothermic fluid discussion I have listed a few related articles:


References

1. Brian J. Murray, M. (1981). "Severe Lactic Acidosis and Hypothermia." The Western Journal of medicine: 162-166.
2. Charles. Smith MD, F. (2001). "Evaluation of a New IV Fluid and Blood Warming System to Prevent Air Embolism." International Trauma care Fall/Winter: 78-82.
3. Charles. Smith MD, F. (2004). "Prevention and treatment of Hypothermia in Trauma patients." International Trauma care Spring: 68-80.
4. Charles. Smith MD, F. (2008). Principles Of Fluid and Blood Warming in Trauma. International Trauma Care. 18: 71-79.
5. David B. Stabb, M. V. J. S., MD; John J. Fath, MD; Sundara B. K. Raman, MD; H. Mathilda Horst, MD; Farouck N. Obeid, MD (1994). "Coagulation Defects resulting from Ambient Temperature Induced Hypothermia." The Journal of Trauma 36(5): 634- 638.
6. Dorraine Day watts, P. A. T., MD; karen Soeken, PhD; Philip Perdue, MD, MPH; Sheilah Dols, MT (ASCP); Christopher Kaufmann, MD, MPH (1998). "Hypothermic Coagulopathy in Trauma: Effect of varying levels of Hypothermia on Enzyme Speed, Platelet function and Fibrinolytic Activity." The Journal of Trauma: Injury, Infection and Critical Care. 44(5): 846-854.
7. Dorraine Day watts, P. M. R., RN; Ray Tricarico, NREMT-P; Frank Poole, EMT-CT; John J. Brown, Jr, EMT-CT; George B. Colson, MDArthur Trask, MD; Samir M. Fakhry, MD (1999). "The Utility of Traditional Prehospital Interventions in Maintaining Homeostasis." Ppehospital Emergency care 3(2): 115-122.
8. S.M.Frank (2001). Consequences of Hypothermia. Current Anaesthesia & Critical care 12, 79-86.
9. Gregory J. Jurkovich, M. (1989). Hypothermia in the Trauma Patient. 4: 111-140.
10. Hans Husum, M. T. O., MD; Mudhafar Murad, MD; Yang Van heng, MD; Torben Wisborg, MD, DEAA; Mads Gilbert, MD, PhD (2002). "Preventing Post-Injury Hypothermia During prolonged Prehospital Evacuation." Prehospital and Disaster Management 17(1): 23-26.
11. Henry Wang, M., MPH; Clifton Callaway, MD, PhD; Andrew Peitzman, MD; Samuel Tisherman,MD (2005). "Admission hypothermia and outcome after major trauma." Critical Care Medicine 33(6): 1296-1301.
12. Jolene B. Fox, R. F. T., MD; Terry P. Clemmer, MD; Michael Grossman, MD (1988). "A Retrospective Analysis of Air-Evacuated Hypothermia Patients." Aviation, Space and Environmental Medicine: 1070-1074.
13. Judy Mikhail, R., MSN, CCRN, CEN (1999). "The Trauma Triad of Death: Hypothermia, Acidosis and Coagulopathy." AACN Clinical Issues 10(1): 85-94.
14. Kathryn Moore, D., RN (2008). "Hypothermia in Trauma." Journal of Trauma Nursing 15(2): 62-64.
15. Larry M. Gentiello, M. G. J. J., MD; Michelle S. Stark, RN, M.N; S. Ahmad Hassantash, MD; Grant E. O'Keefe, MD, M.P.H (1997). "Is Hypothermia in the Victim of Major Trauma protective or Harmful?. A randomized, prospective study." Annals of Surgery 226(4): 439-449.
16. Linda. Lapointe, M. A. N., RN, MS (2002). "Coagulopathies in Trauma Patients." AACN Clinical Issues 13(12): 192-203.
17. Lynne McCullough, M. S. A., MD (2004). "Diagnosis and Treatment of Hypothermia." American family Physician 70(12): 2325-2332.
18. R. Sharyn Martin, P. D. K., Preston R. Miller, J. Jason Hoth, J. Wayne Meredith and Michael C. Chang (2005). "Injury-associated hypothermia: An analysis of the 2004 National Trauma Data Bank." Shock 24(2): 114-118.
19. Rick Y. Peng, M. F. S. B., MD, FACS (1999). "Hypothermia in Trauma
Patients." American College of Surgeons 188(6): 685-696.
20. Robert A. Finkelstein, MDCM, and Hasan B. Alam, MD (2010). “Induced Hypothermia for Trauma: Current Research and Practice. Journal of Intensive Care Medicine. 000(00) 1-22.
21. Sharyn Ireland, R. D. H., B Nurs, Crit Care Cert, ACCN, M.ed (2006). "Nursing and medical staff knowledge regarding the monitoring and management of accidental or exposure hypothermia in adult major trauma patients." International Journal of Nursing Practice 12: 308-318.
22. Weinberg, A. D. (1993). "Hypothermia Special situations." Annals of Emergency Medicine 22(February): 370-377.

 

[Too Old To Work]

The hypothermia - shock connection is very well established, even if Brown isn't aware of it. We've been using warmed fluids in trauma patients (when actually do fluid resuscitation) for almost 10 years based on some of the studies cited in Hebl's last post.

Unfortunately, the military has a lot of recent experience with trauma and shock. Many of those surgeons are also civilian surgeons when they aren't serving in the military. They are learning a lot and bringing a lot of that knowledge back to the civilian world.

They now know, and are telling us, that intubation of trauma patients should be done at the last possible instant because they have seen that it is harmful to patients.

The problem is of course that the publication of this data is taking a while to reach the civilian world.

 

[Smash]

That was a nice sales pitch Dave! Much more subtle than the usual types we get here. It's a pity AV have no money at the moment, but I hope you can move a few units elsewhere though.

 

[Smash]

That was a nice sales pitch Dave! Much more subtle than the usual types we get here. It's a pity AV have no money at the moment, but I hope you can move a few units elsewhere though.

That said, it is a good concept with solid science behind it, which has clearly not been taken up as it probably should. It would be nice to get a few of these out there and see how they go.

 

[Melclin]

Um, this bloke makes it sound like the MAS have them already?

Perhaps check out in the garage in that large white vehicle?

I was being sarcastic because I thought he was trying to flog them. Didn't notice he was from melbourne though.

 

[MrBrown]

This is fascinating; its bloody freezing here what with winter and all so next time we get some bloke who has been bowled over in an RTA perhaps a radiator special is in order

 

[HMartinho]

In Portugal, pre-hospital and intra-hospital doctors and nurses don't use the microwave to heat the fluids. It could be dangerous to the patient.

Anyway, we should not heat a trauma patient, unless that hypothermia was very serious. A mild hypothermia can be beneficial to the trauma patient, especially if there is brain injury. In some portuguese trauma centers, emergency room's and ICU's, doctors and nurses use hypothermia as a therapeutic measure.

 

[usalsfyre]

Therapeutic hypothermia and the mild hypothermia that occurs due to room temperature fluids and loss of thermal regulatory capacity are two massively different things. Unless your doing it deliberately (and at this point that's still an understudied area) then a hypothermic trauma patient is a bad thing.

 

[truetiger]

In Portugal, pre-hospital and intra-hospital doctors and nurses don't use the microwave to heat the fluids. It could be dangerous to the patient.

Anyway, we should not heat a trauma patient, unless that hypothermia was very serious. A mild hypothermia can be beneficial to the trauma patient, especially if there is brain injury. In some portuguese trauma centers, emergency room's and ICU's, doctors and nurses use hypothermia as a therapeutic measure.

I find that interesting, when I was working in the ER (level 2), the first thing we would do if we were expecting a trauma patient would be to crank up the heat. Studies have shown trauma patients that are kept warm do better.

 

[usalsfyre]

I find that interesting, when I was working in the ER (level 2), the first thing we would do if we were expecting a trauma patient would be to crank up the heat. Studies have shown trauma patients that are kept warm do better.

Most trauma bays are at least 85ish degrees for that reason (complete anecdote on my part BTW).

 

[HMartinho]

"Therapeutic hypothermia is a therapeutic technique used by doctors consisting in cooling the body to decrease risk of neurological damage and death after any accident. Induced hypothermia is recommended for babies who experienced problems in childbirth, some individuals who have suffered neurological damage or had respiratory and cardiac arrest.

Induced hypothermia is done when the patient is in coma. For cooling the body doctors use ice packs, heat mats, ice helmet or cold saline directly into the vein of patients, lowering body temperature to 32 ° C. The technique is effective because with the low temperature, the body works more slowly, heartbeat and respiration are smaller resulting in quieter low-energy and oxygen.

This technique can save lives, but also has risks such as pulmonary infection if not applied correctly, so it should be performed only in hospitals and doctors are able to apply the technique, not running the risk of lowering the temperature of the other patient and aggravate over the frame. For the application of induced hypothermia the patient must meet in an Intensive Care Unit (ICU) because it is a place that offers support in the patients after the application of the technique".

translated text from the portuguese article: http://www.tuasaude.com/hipotermia-terapeutica/