To define methodologies to prevent hypothermia in the trauma patient.
- Hypothermia: A body temperature below normal in any victim of trauma
- “Clinical” hypothermia: A core temperature below 35 degrees Celsius in any victim of trauma and is classified as follows:
- Mild hypothermia: 32-35 degrees C
- Moderate hypothermia: 30-32 degrees C
- Severe hypothermia: <30 degrees C
- Patients at risk for hypothermia:
- History of prolonged, cold environmental exposure
- Massive blood and fluid loss with large fluid requirements
- Severe head injury
- Infants and children
- All victims of major trauma are considered “at risk” for hypothermia
- Core temperature should be obtained on all patients with major injuries
- The trauma room temperature should always be maintained at greater than 75 degrees Fahrenheit
- Avoid prolonged patient exposure, i.e., cover with warm blankets. The operating room should be maintained at 85 degrees Fahrenheit.
- Warm blankets should be provided to the patient as soon as possible.
- All fluid going into patient should be warm (available in trauma room).
- For major transfusion requirements, use the Level 1 fluid infuser that will always be kept in the trauma room.
- If hypothermia becomes a problem, obtain the Bair Hugger and apply over as much of the body surface as possible.
- If the patient has severe hypothermia:
- Notify the trauma attending immediately
- Begin aggressive passive re-warming measures:
- Bair Hugger (do not apply a blanket between the Bair Hugger and the patient)
- Increase the temperature on the inspiratory humidifier on the ventilator
- Warm saline down the NG tube
- Consider warm peritoneal lavage
- Consider cardiac bypass if all else fails. Obtain a cardiac surgery consult.
- If the patient has temperature < 36 degrees C monitor temperature every hour. If patient has temperature < 35 degrees C monitor temperature every 30 minutes or continuously via a bladder thermistor.
- The OR Trauma Room will be kept at 80 degrees Fahrenheit.