Hypothermia (and everything else)

What is hypothermia?

Why is hypothermia problematic for the body?

• slows and alters chemical reactions in the body

• heart becomes irritable

How is hypothermia prevented?

• stop external bleeding ASAP

• reduce heat loss

• burrito method

• keep ambulance warm

• ensure IV fluids are warm (if providing)

• warm packs

  • axilla

  • groin

  • neck

  • head

How can we reduce heat loss?

• foil blankets over the skin with insulated coverings (passive rewarming)

• remove wet clothes

• burrito method

• vapour barrier between patient and backboard

  • tarp

  • plastic

  • blanket

What is the “burrito method”?

• wrapping the patient like a burrito

• prevents ongoing convective heat loss

How can warm IV fluids be administered in the truck?

What is the trauma triad of death?

Why can coagulopathy result in acidosis?

coagulopathy → increased lactic acid in blood → acidosis (acidic blood)

How can acidosis result in hypothermia?

acidosis → decreased heart performance → hypothermia (low body temperature)

How can hypothermia result in coagulopathy?

hypothermia → decreased coagulation → coagulopathy

What is coagulopathy?

blood losses the ability to clot

What can cause coagulopathy?

• trauma consumes clotting factors

• hypothermia + acidosis → shuts down clotting pathways

• dilution of clotting factors (too much saline)

• liver cannot produce clotting factors fast enough → hypoperfusion

True or false: hypothermia and acidosis shut down clotting pathways.

true

What can happen if too much saline is given?

What is hypoperfusion?

What are the dangers of coagulopathy?

How can coagulopathy be prevented?

What is acidosis?

What can cause acidosis?

• severe bleeding → decreased blood volume → decreased perfusion → less oxygen to cells

• switch to anaerobic metabolism → production of lactic acid → metabolic acidosis

note: remember the trauma triad of death

What are the dangers of acidosis?

• acidic environment in the blood inactivates enzymes responsible for clotting

• causes heart and brain function to decrease

• eventually = multi-organ failure

How can acidosis be prevented?

• stop external bleeding ASAP

• administer oxygen

• ensure ventilation is adequate

• maintain perfusion (blood pressure)

What is an abrasion?

What is a penetrating wound?

What is a puncture wound?

What is a laceration

What is evisceration

What is avulsion

What is tenting

What is shortening

What is rotation

What is ecchymosis

What is a hematoma

What is an contusion

What are deadly bleed indicators

• steady or pulsatile bleeding

  • may not appear heavy

• location/depth of wound involves danger areas

• patient appears “sick”

• vital signs indicate shock

• multiple injuries

• high energy/dangerous MOI

What are wound care indicators

• wound should be well visualized

• no more than a small amount of oozing collects within the wound

• location/depth involves low risk areas

  • dorsal aspects of limbs

  • areas distal to the wrists

• patient appears well perfused + alert

• vital signs WNL (within normal limits)

• no direct pressure applied prior to arrival

• bleeding has stopped on its own (with all of the above findings also present)

What should be done with any impaled objects

stablilization of object

What should be used to clean surface injuries in (stable) patients

saline (sterlle water)

What should be done with embedded objects

they should be left in place

True or false: large surface contaminants should NOT be removed if possible

false

What should be considered during soft tissue injury management

underlying injuries to deep structures (nerves, vessels, bones, etc.)

What should protruding tissues/organs be covered with

non-adherent materials such as moist, sterile dressings, or plastic wrap

What should be done prior to splint application

dress and bandage open wounds

How can neurovascular status be restored

loosening of bandages

Should digits be wrapped individually or together

individually

Should the tips of fingers/toes be left uncovered or covered

uncovered (unless otherwise indicated by the Standards)

Why do we leave the tips of fingers/toes uncovered

allow for observations of neurovascular status

What are pulse motor sensation (PMS) assessments

• check distal neurovascular function in limbs after injury

• pulse = ensures blood flow

• motor = checks nerve/muscle function

• sensation = detects nerve integrity/sensory changes

When should PMS assessments be done

When is just a pulse check acceptable

What are the 6 P’s (and an A) of the PMS check

What are the steps of an amputation/avulsion assessment

How are amputation/avulsion injuries treated

What happens if a body part(s) cannot be found before transport

• do NOT delay transport

• attempt to engage others at the scene (allied agencies) to look for parts

  • if found, parts can be transported to the receiving facility

What are some important considerations regarding amputation/avulsion injuries

What can be assessed to determine visual disturbances after an eye injury

What should be assumed with all eye injuries

threats to vision

What else is assessed for (besides visual disturbances) in eye injuries

head injury

What should be done if eyelids are swollen shut

nothing (leave them alone)

How should eye injury bleeds be controlled

absolute minimum pressure required

What should be done if injury/pain is severe and injury is unilateral

cover both eyes (affected + non-affected)

When should any kind of manipulation/palpation/irrigation/direct pressure be avoided

if obvious (or suspected) rupture of the globe

What should be done if the eye is extruding (avulsed)

• do NOT replace inside the socket

• cover eye with a moist, sterile dressing

• protect/stabilize as if it is an impaled object

• advise patient to keep eye movements to a minimum

• transport supine with head elevated 30 degrees

How can avulsed eyes be protected and stabilized

What are chemotactic factors

chemicals released by white blood cells that attract more white blood cells to an area of inflammation

What is erythema

Why might ecchymosis not be evident during pre-hospital care

develops over time

What is a crush injury

What is crush syndrome

Dark red hemorrhage can indicate which type of injury

venous injury

Red hemorrhage can indicate which type of injury

capillary injury

Bright red hemorrhage can indicate which type of injury

arterial

Why is it that clean lacerations and amputations may not bleed profusely

What is hyperemia

Why is hyperemia important after an injury

• brings oxygen and phagocytes to the injured area

• draws away the by-product of cell destruction and repair

What are the first cells to arrive to the site of injury during the inflammatory process

granulocytes

What is compartment syndrome

How is compartment syndrome managed

What is necrosis

What is rhabdomyolysis

What are the different compartments of the leg

What are the splinting priorities (according to BLS PCS)

• spine (neck; thoraco-lumbar; head)

• pelvis

• femur

• lower legs

• upper limbs