Hypothermia in Trauma.

Leslian Janet MejaGmez; Tariq Hayat Khan

Author(s)

Leslian Janet MejaGmez Anesthesia in Polytrauma Autonomous University of Mexico (U.N.A.M), Hospital of Traumatology and Orthopedics "Lomas Verdes" I.M.S.S. Mexico City, Mexico

Tariq Hayat Khan Pakistan Resuscitation Society Islamabad Pain & Palliative Care, Islamabad, Pakistan

Abstract

The number of polytrauma patients in high energy accidents brought to trauma centers is increasing day by day. For their management we require a multidisciplinary team capable of performing lifesaving maneuvers following the sequence of resuscitation protocols. The physiological response in a patient with trauma is usually hypovolemic shock. The compensatory mechanisms are activated to improve redistribution of the flow and maintain systemic vascular resistance. During the transitional period rational and goal-directed fluid therapy and prevention of inadequate tissue perfusion and impaired metabolic exchange at the microcirculatory level take precedence. Trauma kills by acidosis, hypothermia and coagulopathy- together called the "mortal triad"- which develop as a consequence of the metabolic changes induced by polytrauma. Hypothermia as part of the triad in the polytrauma patient is an indicator of injury severity and is associated with an increase in mortality. In the case of trauma patients, the presence of hypothermia is related to inability of the body systems to maintain temperature in the face of increased heat loss, decreased production and/or alterations in thermoregulation. The hemodynamic response to the decrease in temperature begins with peripheral vasoconstriction, myocardial dysfunction and electrical instability develops as a consequence of the metabolic changes induced by polytrauma. The complications of hypothermia include activation of the coagulation cascade, triggering of acidosis, endothelial dysfunction, inflammatory cascade activation, consumption coagulopathy, hypoxia, cell death, multiple organ dysfunction etc. This review highlights the main aspects of the pathophysiological derangements occurring as a result of trauma.

Publication Details

Page(s) 232-240

DOI DOI not available

Published Journal: Anaesthesia, Pain and Intensive Care, Volume: 21, Issue: 2, Year: 2017

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References

2015.,Sci 20 46 -51

2016., 3 268 -274

., 2349 -

., -

Emergencies, ., -

2002.,McGraw Hill 1346 -1360

C l, .a s s i f i c a t i o n 2 0 0 0 - 2 0 0 1, -

.,WHO/PCS/01 -

Organization, 2001., -

2005.,Med 20 346 -350

1976., 35 221 -227

O I, 1988.L a n k a . F o r e n s i c S c i I n t,d o i . o r g / 1 0 . 1 0 1 6 / 0 3 7 9 - 0738 90220 -4

KamenczakA,Jasi?,-KolawaK,TargoszD,SzkolnickaB,SancewiczPach K, 1997.Acute pesticides poisoning in the Krakow Department of Clinical Toxicology in 1986-1995, 54 671 -6

StefanosNK,DavidCC, 2004.Acute chemical emergencies,New Eng J Med 350 800 -8

du ToitPW,MullerFO,VanTonderWM,Ungerer MJ, 1998.Experience with intensive care management of organophosphate insecticide poisoning,S Afr Med J 60 227 -9

SrinivasR,VenkateswarluV,SurenderT,EddlestonM,NickAB, 2005.Pesticide poisoning in south India: Opportunities for prevention and improved medical management,Trop Med Inter Health 10 581 -8

SafdarA,SaeedA,Muhammad NR,AhmedSM,DasB,NadeemA,SamalRK, 2014.Survival pattern in patients with acute organophosphate poisoning on mechanical ventilation: A retrospective intensive care unit-based study in a tertiary care teaching hospital,Indian J Anaesth 58 126780 -5049

MuleyA,ShahC,LakhaniJ,BapnaM,MehtaJ, 2014.To identify morbidity and m o r t a l i t y p r e d i c t o r s i n a c u t e organophosphate poisoning,d o i : 10 18 132488 -5229

AygunD,DoganayZ,AltintopL,GuvenH,OnarM,DenizT, 2002.Serum acetylcholinesterase and prognosis of acute organophosphate poisoning,J Toxicol Clin Toxicol 40 903 -10

SinghJ,KapoorD,SinghM,AnandLK, 2016.Plasma cholinesterase levels in acute organophosphorus poisoning: a plausible marker for weaning?,Anaesth Pain & Intensive Care 20 477 -479

HiremathP,RangappaP,JacobI,RaoK., 2016.Pseudocholinesterase as a predictor o f m o r t a l i t y a n d m o r b i d i t y i n organophosphorus poisoning,Indian J Crit Care Med 20 601 -604

EddlestonM,BuckleyNA,EyerP,DawsonAH, 2008.Management of acute organophosphorus pesticide poisoning,Lancet 371 597 -607