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MT System PI

MT System PI. Hypothermia in trauma Up to 66% critically injured ARRIVE hypothermic, irrespective of ambient temperature Continue to lose heat during resuscitation “Normothermia” philosophy difficult in rural environment Trauma Triad: hypothermia + acidosis + coagulopathy.

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MT System PI

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  1. MT System PI • Hypothermia in trauma • Up to 66% critically injured ARRIVE hypothermic, irrespective of ambient temperature • Continue to lose heat during resuscitation • “Normothermia” philosophy difficult in rural environment • Trauma Triad: hypothermia + acidosis + coagulopathy

  2. The Lethal Triad Acidosis Hypothermia Death Coagulopathy Brohi, K, et al. J Trauma, 2003.

  3. Hypothermia, Acidosis & Coagulopathy “Lethal Triad” in critical trauma patients: + Persistent core hypothermia + Metabolic Acidosis + Inability to establish hemostasis = reflections of degree of shock & insufficient resuscitation Difficult to reverse Key: appropriate assessment

  4. JOT article July Suppl, 2011 Military study: 2 Iraq military patient groups 2003-04 compared to 2007-08 • 50% decrease in deaths between 2 groups (47% vs 20%)! Strategies, due to; + Trauma Systems approach; tiered evacuation w/increasing capabilities (sound familiar?) + PI projects; Prevention of hypothermia + Transfusion strategies WB/FFP/Platelets,61% decrease crystalloid infusion

  5. + Prehospital Care Strategies: • Small IV boluses to return of radial pulse • Use of Tourniquets • Hypothermia Prevention/Management Kits w/ torso warmer, wrapping, hats & forehead temp dots

  6. PLUS • Priority of JTTS Clinical Practice Guidelines for Hypothermia Prevention, Monitoring & Management in all aspects/phases & for all providers of care components; • Planning • Hypothermia Mge kits for transportsfor urgent litter, intubated or immediate triage categories • Warmed IV fluid, ambient temps, air warmers • Documentation of temps by everyone • Guidelines for POI through all levels of care

  7. Hypothermia in trauma • Occurs irrespective of ambient temp • Prevention much easier than treatment • Earlier, the better • Layered approach w/lightweight, durable, cost-effective products located as close to injury as possible • Utilized “up the chain” of care phases by all, including ground/air evac • Core temp best, but Temp Dots on foreheads can ID trends & act as reminder for approach • Keep ambient temps >85-90 • Warm IV fluids, blankets, air warmers

  8. MT questions in considering “normothermia philosophy”; • Do we have a problem w/trauma patients arriving with some degree of hypothermia? • Are there similarities between military & rural systems with limited resources, geographic distances, “austere environments”and variable pre-hospital times we could capitalize on? • Are there similar , cost-effective strategies we could easily implement to make a difference for bleeding patients for all phases of care in MT?

  9. “Not just for hypothermia patients anymore” • Traditionally reserved for “hypothermia” patients • Traditionally back-country, remote locations, winter &/or wet weather • ALL significantly bleeding patients regardless of response/transport times & “take it to the streets” • ALL phases of care & providers use philosophy, principles & equipment across disciplines & locations- LINKAGES key

  10. Proposed to STCC -Everyone to focus on and track initial temperatures rest of 2011 • Note those w/some degree of hypothermia on admission to ER (< 96 F or 32 C) • Note whether warming measures were implemented; + Active rewarming w/resuscitation + Prevention of further heat loss w/transport &resuscitation - SHARE “Normothermic” philosophy & focus efforts

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