truetiger
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This says nothing what so ever about trauma. Hypothermic trauma patients can experience coagulopathy and lower threshold for v-fib. As said before, it is recommended they be kept above 85 degrees.
Normothermic Fluid Administration
- Thread starter Hebl
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The key word here being "induced". The uncontrolled cooling because your dumping room temperature fluid in, have them stripped naked in the A/C and they're shunting blood to core is neither induced nor therapeutic.
Unless you've got a plan and are continuously monitoring temperature to get them deliberately into the therapeutic range keep them warm.
Unless you've got a plan and are continuously monitoring temperature to get them deliberately into the therapeutic range keep them warm.
firetender
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great article! thanks.
Once again, it shows how much we don't know. There are heavy proponents now for induced hypothermia in the field, Dr. Bryan Bledsoe amongst them and what you present here is a cautionary note to not get too excited about getting this onto EMS trucks.
Once again, it shows how much we don't know. There are heavy proponents now for induced hypothermia in the field, Dr. Bryan Bledsoe amongst them and what you present here is a cautionary note to not get too excited about getting this onto EMS trucks.
I'm just saying what some portuguese doctors believes. Of course, here there are also doctors, nurses and EMT-B who do not believe in this technique. In my operational area, none of the emergency rooms using therapeutic hypothermia in trauma patients.
BTW, the risk of coagulopathy can not be diminished with the administration of heparin or other similar drugs?
BTW, the risk of coagulopathy can not be diminished with the administration of heparin or other similar drugs?
truetiger
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Giving heparin or anything similar would be a terrible idea....
I believe that therapeutic hypothermia applied by people with training, can be very beneficial.
Thanks for the reply. I was asking because I've never seen anyone actually administer heparin in these situations.
I think without a lot more evidence and consensus, recommending that for field use is inapprpriate. There's a big difference between deliberate and controlled hypothermia, and doing it in the field which by it's nature is uncontrolled. Neuroprotection is an entirely different scenario than what we're talking about here.
When they get to my OR, I'll be warming all their fluids and blood products, and using forced air warming to keep their temp UP. Cool patients don't clot near as well, nor do their hearts appreciate it. Severely traumatized patients getting lots of blood products are already at high risk for DIC, and hypothermia just makes things worse.
Heparin in a severely traumatized patient? Not a snowballs chance.
It can be and is beneficial...post cardiac-arrest and MAYBE (jury is still out on this one and I think a new study is supposedly going to look at it again) during an ischemic stroke...but not for a patient with serious trauma, or even an isolated TBI.
As has been said though, it has to be controlled; the core temp needs to be maintained at 32-34C continuously; allowing the body to warm after cooling has been started doesn't work out so well, which leaves a lot of prehospital systems out; if you can't accurately measure the core temp and prevent the body from warming itself (shivering) probably not a good idea to start.
Melclin
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Our intensive care paramedics are cooling ROSC and isolated TBI pts in the field here. The later is part of the POLAR study.
http://www.anzicrc.monash.org/polar-rct.html
http://www.anzicrc.monash.org/polar-rct.html
Now that is interesting. Looks like it's been recruiting patient's for about a year, any word at this point on what the results are looking like or how many people have been entered? (the fact that it hasn't been cancelled does make it look promising, or at least not completely harmful)