Recognizing and Treating Hypothermia in Trauma Patients

As an EMS worker, you probably know first hand how hypothermia can affect your patient and your treatment of a patient. However, when your patient is in some sort of traumatic shock, hypothermia may take a step back when considering if the patient needs CPR, fluid resuscitation or hemostasis. These tasks typically seem to take priority, but you have to also remember to treat for hypothermia to ensure the safety of your patient. Hypothermia is characterized by having a core temperature of fewer than 35 degrees Celsius. As the body temperature lowers, the more serious and dangerous the complications will be.

Dangerous and deadly outcomes

The consequences of hypothermia can be extremely dangerous and deadly to your patients. There are numerous complications that can arise from hypothermia, and it can be fatal for some. Unfortunately, the adverse effects of hypothermia can be much worse for trauma patients when compared to exposure victims. A 2004 study performed by Tsuei and Kearney found that there was a 100% mortality rate in trauma patients whose core temperature dropped to 32 degrees as compared to only a 21% mortality rate in non-trauma patients. There may be a scientific explanation for this. Weirdly enough, many animal studies have found that an injured animal’s shivering reflex is delayed and will begin at a lower body temperature than those of an uninjured animal who is exposed to cold temperatures. Delaying our shivering response in the trauma victim will delay how quickly the body can begin to warm itself.

Causes of hypothermia

The most common cause of hypothermia is typically the environment. If you are exposed to extremely cold temperatures, your core temperature will begin to fall. However, there are other factors that can cause hypothermia. In a trauma, patient hypothermia may set in because of blood loss or a traumatic brain injury that could inhibit or impair the body’s ability to regulate its temperature or properly activate the shivering reflex. Hypothermia can also be brought on or made worse by consuming too much alcohol. You may even need to look into the use of room temperature IV crystalloid fluids if the patient is in their advanced or early stage of life or if the patient has diabetes as contributing factors of hypothermia even if the environment is not extremely cold.

Identifying the symptoms

You have to be extremely alert and aware when recognizing the symptoms of traumatic hypothermia. Here are a few of the obvious and not as obvious indications of hypothermia:

• Shivering, which may or may not be present in an injured patient

• Their skin may appear to be blotchy or spotty

• A rapid heart rate that ultimately starts to slow

• Mental capacity that changes, noticeably confused or has poor judgment

• Quick respirations that inexplicably starts to slow

Unfortunately, in emergency situations, diagnosing traumatic hypothermia will be extremely difficult. This is why hypothermia in many trauma patients must be assumed until ruled out.

Prevention and treatment

Here are a few tips that can help protect and prevent the adverse effects of hypothermia in a trauma patient:

• When possible use warm IV fluids to treat your patient

• Remove any wet clothing the patient is wearing

• Use thermal blankets that are made to prevent and hinder the effects of hypothermia

• If you do not have a thermal blanket, use any blanket on hand, such as fleece, cotton, polyester, etc. to help warm the victim

It is extremely important to keep a trauma victim with hypothermia warm. You need to help them preserve the body heat that they have left. One of the most important things to do is recognize this problem in your patient. Once you recognize the problem, then you can take the necessary steps needed to keep the patient warm and prevent their body temperature from falling more. Remember to stay alert and vigilant and do everything you can to ensure your patient’s safety.