AGR416 wrote:-Prevent hypothermia; they should have covered the pt up with a space blanket, poncho or other item to prevent a drop in temperature.
Here's a good read AGR from a PowerPoint called 'Trauma Triad' by Max Dodge, an NREMT-P Flight Medic.
"So, what is this Lethal Triad?
The trauma triad of death is a medical concept describing the combination of blood loss leading to hypothermia and acidosis which then leads to coagulopathy which prevents clotting and exacerbates hemorrhage.
This combination is commonly seen in patients who have sustained severe traumatic injuries and results in a significant rise in the mortality rate.
It is a vicious bloody cycle...
Core temperature is controlled by the hypothalamus. The human body maintains core temperature at about 37 degrees Centigrade. Depending on what literature you read, hypothermia starts at 36C. Shivering thermogenesis starts around 35C. Shivering generates heat but consumes more energy reserves. Substrates for this heat generation rely mostly on the metabolism of glucose at about 2-5X the basal rate. Shivering also increases consumption of oxygen, which we determined previously was not something we have in abundance.
43% of combat trauma patients come to role 2 & 3 facilities with core temperatures less than 36C. Normothermic patients have a 97.5% survival rate. Hypothermic patients have a >75% survival rate. Patients with a temperature of 33C or less had a 100% mortality rate.
Hypothermia spurs a catecholamine release, steroid release and release of tissue thromboplastin from the ischemic tissue. Coupled with peripheral vasocontriction from both the hypothermia and the compensatory effects of shock, the ground work is set for disseminated intravascular shock (DIC). Furthermore, the cold strongly inhibits the enzymatic reactions of the coagulation cascade making it nearly impossible for the body to naturally create blood clots and staunch major bleeding...
So how do we interrupt this death spiral?
Tourniquets should be placed as high as possible every time. Cinch them down with the buckle and tighten them until bleeding stops.
Wound packing and pressure need to be applied to bleeds tourniquets can’t touch. All the newfangled gauze in the world won’t help the medic who can’t pack a wound and hold good pressure for three minutes. Crewchiefs can help here!
Keep the patient warm! Prevent heat loss through wind and exposure.
Titrate appropriate fluids to blood pressure (peripheral pulses). Overload will kill."