HYPOTHERMIA, COAGULOPATHY, AND ACIDOSIS
Section snippets
Monitoring
In humans, hypothermia is defined as a core body temperature below 35°C. A decreasing core temperature leads to physiologic abnormalities (Table 1). The ideal way to measure temperature would be continuous, accurate, minimally invasive, easy to use, and inexpensive. No existing monitoring system fulfills all these criteria. Methods that have been used include measurement of the temperature of the skin, oro- or nasopharynx, esophagus, tympanic membrane, bladder, rectum, and pulmonary arterial
Diagnostic Methods
Coagulopathy—as part of the deadly triad of hypothermia, coagulopathy, and metabolic acidosis—is common. Its presence is first suggested to the surgeon by diffuse oozing of all cut surfaces. Four events contribute to post-traumatic coagulopathy: hemodilution, consumption of clotting factors, hypothermia, and metabolic derangements (e.g., acidosis). Dilutional thrombocytopenia is the most common coagulation abnormality in trauma patients, and is particularly common in patients receiving more
Monitoring
Acidosis is defined as an arterial pH less than 7.36. Although respiratory acidosis is not uncommon in the critically ill trauma patient, the acidosis of most interest in this situation is the lactic type of metabolic acidosis. In addition to pH, other indicators also can suggest that a state of oxygen debt exists: base deficit and serum lactic acid levels.
Arterial pH must be interpreted in the context of arterial carbon dioxide tension. Analysis of the arterial P co2 helps to differentiate a
SUMMARY
The management of patients requiring a damage control approach taxes the abilities of the best equipped trauma center. These patients present with severe metabolic abnormalities, most notably characterized by a deadly triad of hypothermia, coagulopathy, and acidosis. Using volumetric, oximetric pulmonary artery catheters, hypothermia and any ongoing cardiovascular abnormalities can be identified quickly and treatment can be monitored. External, forced air rewarming is a valuable technique in
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Address reprint requests to Virginia A. Eddy, MD, Division of Trauma, Section of Surgical Sciences, Department of Surgery, Vanderbilt University Medical Center, 243 Medical Center South, Nashville, TN 37212
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Division of Trauma, Section of Surgical Sciences, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee