Pre-Hospital Use of Intravenous In-Line Fluid Warmers to Reduce Morbidity and Mortality for Major Trauma Patients: A Review of the Current Literature

Collins, Nicholas; Daly, Stuart; Johnson, Patricia A.; Smith, Gavin

doi:10.33151/ajp.12.2.139

Cited by 6 publications

(8 citation statements)

References 24 publications

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“…Secondly, lower than desirable ambient temperatures inside the Emergency Department may also have played role. It is recommended that emergency departments should maintain an inside ambient temperature of between 21 and 24°C [4]. The ambient temperature in the triage area of the participating facility was measured at less than the recommended 21°C in 95/140 (67.9%) of the cases.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, crews were unable to effectively increase the ambient temperature inside the patient compartment of the ambulance. This is unfortunate, as passive rewarming has been shown to be a very effective method to increase the patient's temperature and reduce cold discomfort during transport [4]. Clinically significant hypothermia however requires a more aggressive approach involving active rewarding.…”

Section: Discussionmentioning

confidence: 99%

“…There are several clinical and environmental risk factors that promote the development of hypothermia in trauma patients [3]. Clinical factors include: hypoxia, tachycardia, hypotension and decreased level of consciousness [4]. Environmental factors involve contact with cold surfaces, exposure to decreased ambient temperatures and the administration of cold intravenous fluids [4].…”

Section: Introductionmentioning

confidence: 99%

“…Clinical factors include: hypoxia, tachycardia, hypotension and decreased level of consciousness [4]. Environmental factors involve contact with cold surfaces, exposure to decreased ambient temperatures and the administration of cold intravenous fluids [4]. The reported incidence of hypothermia in trauma cases varies and has been cited as being between 12 and 66%.…”

Section: Introductionmentioning

confidence: 99%

“…The reported incidence of hypothermia in trauma cases varies and has been cited as being between 12 and 66%. In the majority of studies the coexistence of hypothermia with trauma has been linked to poorer outcomes [4-7]. Consequently the “triad of death“ has become a recognized term referring to the combination of hypothermia, acidosis and coagulopathy which, in combination, lead to an increased mortality rates [5, 8, 9].…”

Section: Introductionmentioning

confidence: 99%

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Hypothermia in trauma patients arriving at an emergency department by ambulance in Johannesburg, South Africa: a prospective study

Vincent-Lambert¹,

Smith²,

Goldstein³

2018

Pan Afr Med J

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Introduction Normal body temperature is considered to be between 36 and 38°C. Temperatures that are too low may negatively affect physiological functions. In trauma cases, factors that promote the development of hypothermia include concomitant hypoxia, hypotension, decreased levels of consciousness, contact with cold surfaces, exposure to low ambient temperatures and the administration of cold fluids. Studies on emergency department related hypothermia in Africa are sparse. This study investigated instances of hypothermia in a sample of trauma cases arriving by ambulance to an emergency department in Johannesburg, South Africa. Methods Core body temperatures of 140 trauma cases were measured upon arrival and 30 minutes later. Ambient temperatures outside the hospital, inside the ED and in the resuscitation areas were also recorded. Additional information was gathered describing the equipment available to the ambulance crews for temperature, control and rewarming. Results Seventy-two (51%) of the cases were found to have core body temperatures less than 36°C upon arrival. Twenty-nine (21%) the cases were considered clinically hypothermic (core temperatures of less than <35°C). After 30 minutes, 79 (56%) of the participants had core body temperatures of less than 36°C and 39 (28%) remained lower than 35°C. Patients were not warming up in the ED as expected. Rather, some had become colder. The study also found that the ambient temperature in the triage area fluctuated and was recorded as less than the recommended 21°C in 95 (68%) of the cases. In addition, the majority of ambulances that transported these cases lacked appropriate equipment on board to properly facilitate temperature control and rewarming. Conclusion Fifty-one percent of the trauma cases arriving by ambulance had core temperature <36°C. Many became even colder in the ED. Attention needs to be given to the early identification of hypothermia, the regulation of ambient temperatures inside the ED including the provision of appropriate heating and rewarming devices on ambulances.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Hypothermia in trauma patients arriving at an emergency department by ambulance in Johannesburg, South Africa: a prospective study

Vincent-Lambert¹,

Smith²,

Goldstein³

2018

Pan Afr Med J

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Emergency first responder management of combat injuries to the torso in the military, remote and austere settings

Sandhu¹,

Claireaux²,

Downes³

et al. 2020

BMJ Mil Health

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Traumatic injuries to the torso account for almost a quarter of all injuries seen in combat and are typically secondary to blast or gunshot wounds. Injuries due to road traffic collisions or violence are also relatively common during humanitarian and disaster relief efforts. There may also be multiple injured patients in these settings, and surgical care may be limited by a lack of facilities and resources in such a non-permissive environment. The first responder in these scenarios should be prepared to manage patients with severe injuries to the torso. We aim to describe the management of these injuries in the military and austere environment, within the scope of practice of a level 5 registered prehospital practitioner.

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Changes in temperature in preheated crystalloids at ambient temperatures relevant to a prehospital setting: an experimental simulation study with the application of prehospital treatment of trauma patients suffering from accidental hypothermia

Jensen,

Rentzhog,

Herlitz

et al. 2024

BMC Emerg Med

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Background Accidental hypothermia is common in all trauma patients and contributes to the lethal diamond, increasing both morbidity and mortality. In hypotensive shock, fluid resuscitation is recommended using fluids with a temperature of 37–42°, as fluid temperature can decrease the patient’s body temperature. In Sweden, virtually all prehospital services use preheated fluids. The aim of the present study was to investigate how the temperature of preheated infusion fluids is affected by the ambient temperatures and flow rates relevant for prehospital emergency care. Methods In this experimental simulation study, temperature changes in crystalloids preheated to 39 °C were evaluated. The fluid temperature changes were measured both in the infusion bag and at the patient end of the infusion system. Measurements were conducted in conditions relevant to prehospital emergency care, with ambient temperatures varying between − 4 and 28 °C and flow rates of 1000 ml/h and 6000 ml/h, through an uninsulated infusion set at a length of 175 cm. Results The flow rate and ambient temperature affected the temperature in the infusion fluid both in the infusion bag and at the patient end of the system. A lower ambient temperature and lower flow rate were both associated with a greater temperature loss in the infusion fluid. Conclusion This study shows that both a high infusion rate and a high ambient temperature are needed if an infusion fluid preheated to 39 °C is to remain above 37 °C when it reaches the patient using a 175-cm-long uninsulated infusion set. It is apparent that the lower the ambient temperature, the higher the flow rate needs to be to limit temperature loss of the fluid.

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Pre-Hospital Use of Intravenous In-Line Fluid Warmers to Reduce Morbidity and Mortality for Major Trauma Patients: A Review of the Current Literature

Cited by 6 publications

References 24 publications

Hypothermia in trauma patients arriving at an emergency department by ambulance in Johannesburg, South Africa: a prospective study

Hypothermia in trauma patients arriving at an emergency department by ambulance in Johannesburg, South Africa: a prospective study

Emergency first responder management of combat injuries to the torso in the military, remote and austere settings

Changes in temperature in preheated crystalloids at ambient temperatures relevant to a prehospital setting: an experimental simulation study with the application of prehospital treatment of trauma patients suffering from accidental hypothermia

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