Major Ken Wishaw FANZCARoyal Australian Army Medical Corps

Hypothermia

Awareness

Detection

Management

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

Core Temperature below   35.0o C quadruplesmortality in severe trauma. 

Core Temperature below   35.0o C quadruplesmortality in severe trauma. 

Is this a problem in Australia?

Core Temperature below   35.0o C quadruplesmortality in severe trauma. 

Qld Trauma Registry

13% < 35°C

Core Temperature below   35.0o C quadruplesmortality in severe trauma.

Qld Trauma Registry

Over half the cases happen after hospital admission.

ADF Anaesthesia Craft Group Position paper 

“Hypothermia and the Battle Casualty”April 2010.

Why we don’t detect the problem

Heat distributionvs  

environment temperature

Heat distributionvs  

environment temperature

Redistribution HypothermiaHypovolaemic Shock 

Resuscitation 

Awake Anaesthesia

•Core temperature does NOT measure heat loss

•Peripheral temperature more reliable indicator

Detecting hypothermia

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Commonsense,  version 1.1.1

warm legs = warm heart

•Passive warming is minimally effective

•Warm cotton blankets do not work

•Active warming techniques must be used

•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.

NSN: 6515-01-532-8056Cost: $93.00