Hypothermia – The forgotten killer of the trauma patient
Carlos Zapa Hernandez
MD, Specialist in critical medicine and intensive care / tactical and operative medicine, Colombia
Why is it so important?
Remember that the diamond of death in trauma is acidosis, coagulopathy, hypocalcemia, and HYPOTHERMIA. These 4 factors will lead our patient to certain death if their presence is not treated in a timely and aggressive manner. One factor feeds the other, so treatment must be integral and a priority in our care algorithm.
Below 35 °C the body experiences the first signs and symptoms of hypothermia even in hot environments, remember that when the patient bleeds, not only is he losing valuable hemoglobin that we need to transport oxygen (DO2), we also lose body heat from accelerated form, and it is one of the typical errors in the patient with bleeding in hot environments, to think that hypothermia is not going to occur, FATAL to think like that.
Hypothermia deviates the hemoglobin dissociation curve to the left, making it more related to oxygen, causing 02 not to reach the cell causing historical hypoxia, the patient will saturate 100% but that oxygen does not reach the cell causing it to maintain its energy production (ATP) from an efficient aerobic metabolism (with O2) that produces 34 ATP, CO2 and water to a less efficient anaerobic metabolism (without O2) that produces 2 ATP and lactic ACID, which leads the cell to function worse and increase the plasma acid load, this acidosis together with hypothermia causes the coagulation cascade not to be activated correctly and as a consequence we will have a bleeding patient that DOES NOT COAGULATE.
Coagulopathy can be further exacerbated by hemodilution of platelets and coagulation factors due to the use of CRISTALOIDS in resuscitation.
The bleeding worsens the loss of heat, the loss of heat plus hypothermia, more hypothermia that causes more acidosis and so again and again the diamond feeds until it kills you. Now do you understand why hypothermia is something you should take very seriously? Train and equip yourself to always face it!