Hypothermia and the battle casualty Wishaw


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Hypothermia and the battle casualty Wishaw

  1. 1. Major Ken Wishaw FANZCA Royal Australian Army Medical Corps
  2. 2. Hypothermia Awareness Detection Management
  3. 3. Complications of Mild  Hypothermia (35°C)  wound healing is delayed  wound infections are increased threefold  platelets do not work  coagulation fails  blood loss increases 30 ‐100%  need for transfusion increases 30%  Myocardial events  occur in 50%  with IHD
  4. 4. Core Temperature below   35.0o C  quadruples mortality in severe trauma. 
  5. 5. Core Temperature below   35.0o C  quadruples mortality in severe trauma.  Is this a problem in Australia?
  6. 6. Core Temperature below   35.0o C  quadruples mortality in severe trauma.  Qld Trauma Registry 13% < 35°C
  7. 7. Core Temperature below   35.0o C  quadruples mortality in severe trauma. Qld Trauma Registry Over half the cases happen after hospital  admission.
  8. 8. ADF Anaesthesia Craft Group Position  paper  “Hypothermia and the Battle Casualty” April 2010.
  9. 9. Why we don’t detect the  problem
  10. 10. Heat distribution vs   environment temperature
  11. 11. Heat distribution vs   environment temperature
  12. 12. Redistribution Hypothermia Hypovolaemic  Shock  Resuscitation  Awake Anaesthesia
  13. 13. •Core temperature does NOT measure  heat loss •Peripheral temperature more reliable  indicator
  14. 14. Detecting hypothermia A F2010 H Commonsense,  version 1.1.1
  15. 15. warm legs = warm heart
  16. 16. •Passive warming is minimally effective •Warm cotton blankets do not work •Active warming techniques must be used
  17. 17. •Remove casualty from cold wet and windy environment. •Remove and replace wet clothing. •Insulate head and neck with beanie or balaclava if appropriate. •Cover patient. •Insulate underneath patient to protect from cold ground. •Insulate underneath stretcher e.g. using camping mat or second sleeping bag. •Apply active warming devices if available. •Warm IV fluids. •Do not use ad hoc warming techniques directly against casualty’s skin. This may result in burns.
  18. 18. NSN: 6515-01-532-8056 Cost: $93.00