Effects of hypothermia

Hypothermia is commonly observed in trauma patients. Immobility leads to heat loss by conduction and convection. Frequently alcohol is involved, leading to peripheral vasodilatation. Medical treatment can intensify heat loss by exposing the body. The decrease in central body temperature is correlated with the Injury Severity Score. In severely injured patients, particularly those with head injuries, shivering is not observed, indicating altered thermoregulation.

Hypothermia poses a severe threat to the patient. A core temperature below 35 °C alters the coagulability of the blood by retarding the function of coagulation enzymes. The platelet count is decreased due to sequestration of platelets in the liver and spleen. Platelet aggregation is decreased and fibrinolytic activity is increased. Disseminated intravascular coagulation (DIC) is promoted by a number of factors, all contributing to further hemorrhagic shock. Platelet dysfunction appears to be the most important of these factors.

A temperature below 32 °C in trauma patients hardly ever leads to survival without rewarming using rapid warming fluid infusers, peritoneal lavage, hemodialysis, or cardiovascular bypass. The combination of severe hypothermia and hemorrhagic shock is considered detrimental. Therefore some prefer to keep operative procedures in the initial phase as limited as possible with emphasis on control of surgical bleeding (and resection of injured bowel), allowing for a rewarming of the patient and thus obtaining control over the coagulation physiology before restorative surgery is performed 24 to 48 h later.

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