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/clinical/references/trauma-manual/practice-guidelines/hypothermia-prevention/

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Clinical Hub,References,Level I Adult Trauma Center Manual,Practice Guidelines

Hypothermia Prevention

Hypothermia Prevention - Clinical Hub, References, Level I Adult Trauma Center Manual, Practice Guidelines

Focus

Objective

To define methodologies to prevent hypothermia in the trauma patient.

Definitions

  1. Hypothermia: A body temperature below normal in any victim of trauma
  2. “Clinical” hypothermia: A core temperature below 35 degrees Celsius in any victim of trauma and is classified as follows:
    1. Mild hypothermia: 32-35 degrees C
    2. Moderate hypothermia: 30-32 degrees C
    3. Severe hypothermia: <30 degrees C
  3. Patients at risk for hypothermia:
    1. History of prolonged, cold environmental exposure
    2. Massive blood and fluid loss with large fluid requirements
    3. Severe head injury
    4. Infants and children
    5. Burns
    6. Drowning

Guidelines

  1. All victims of major trauma are considered “at risk” for hypothermia
  2. Core temperature should be obtained on all patients with major injuries
  3. The trauma room temperature should always be maintained at greater than 75 degrees Fahrenheit
  4. Avoid prolonged patient exposure, i.e., cover with warm blankets. The operating room should be maintained at 85 degrees Fahrenheit.
  5. Warm blankets should be provided to the patient as soon as possible.
  6. All fluid going into patient should be warm (available in trauma room).
  7. For major transfusion requirements, use the Level 1 fluid infuser that will always be kept in the trauma room.
  8. If hypothermia becomes a problem, obtain the Bair Hugger and apply over as much of the body surface as possible.
  9. If the patient has severe hypothermia:
    1. Notify the trauma attending immediately
    2. Begin aggressive passive re-warming measures:
      1. Bair Hugger (do not apply a blanket between the Bair Hugger and the patient)
      2. Increase the temperature on the inspiratory humidifier on the ventilator
      3. Warm saline down the NG tube
      4. Consider warm peritoneal lavage
      5. Consider cardiac bypass if all else fails. Obtain a cardiac surgery consult.
  10. 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.
  11. The OR Trauma Room will be kept at 80 degrees Fahrenheit.