Hypothermia in Trauma

Hypothermia in a trauma patient is classified differently than environmental hypothermia: mild (36–34 °C), moderate (34–32 °C), or severe (below 32 °C). Oxygen debt is increased as hypothermia causes an increase in oxygen consumption and a reduction of oxygen release from hemoglobin to tissues. In addition, hypothermia causes altered platelet function, altered enzyme kinetics of the coagulation cascade and increased fibrinolysis. Thus affecting hemostasis and leading to greater fluid administration, increased blood transfusions, and longer hospital stays. These effects are directly reversible with the correction of hypothermia.

Bernabei found that 12% of patients arrived in the emergency department hypothermic, and 92% became more hypothermic during the initial evaluation.

Jurkovich found that in 71 hypotensive adult trauma victims with a core temperature, independent of other factors, less than 32°C was associated with 100% mortality.

Prevention of hypothermia in the ED:

• Use warmed fluids
• Keep the room at physiologic temperature of 28°C (that will make you sweat)
• Keep the patient covered with warmed blankets or reflective material
• Re-warming a patient is suggested in accordance with environmental hypothermia re-warming

What about “suspended animation”? Some have proposed that hypothermia may provide a protective mechanism during shock. There are current trials evaluating induced hypothermia in trauma patients. Until further word, preventing and correcting hypothermia is recommended.

Tsuei BJ, Kearney PA. Hypothermia in the trauma patient. Injury. 2004;35:7–15.

Jurkovich GJ, Greiser WB, Luterman A, Curreri PW. Hypothermia in trauma victims: an ominous predictor of survival. J Trauma. 1987;27:1019–1024.

Duchesne JC, et al. Damage control resuscitation: the new face of damage control. J Trauma. 2010 Oct;69(4):976-90.