When "Chilling Out" Goes Bad

Trauma and hypothermia. In a traumatic injury situation we need to be on the lookout for hypothermia. Hypothermia can set in rather quickly and you need to know the symptoms and what to do in case you see it because a trauma victim can become hypothermic even on a warm day.

In a traumatic injury, loss of blood starts a cascade of potentially fatal problems which may not present themselves until days after the incident. Blood helps us carry O2, get rid of CO2 and has clotting factors which help us in the event of an injury. Losing that blood can cause lots of things to happen simultaneously.

In a hemorrhagic injury, blood is diverted to areas which are extremely sensitive to good perfusion (delivery of oxygen to the cellular level) like the liver, kidneys, gut, brain, etc. In this situation, it can actually divert blood away from the hypothalamus, which is the body’s “thermostat”, if you will, which will cause thermoregulation issues and cause body temperature to drop. When body temperature starts to drop, bad things happen. Our body can’t clot effectively, which means we bleed more. We’ve already lost a degree of capability to deliver oxygen and remove waste, so as we have less oxygen, our cells begin to create energy in an inefficient manner which yields even more waste, which we can’t get rid of, and this leads to a high acid pH level in the body. As all of this occurs, we are becoming more hypothermic, which leads to more clotting issues and so forth and so on.

Mild hypothermia is characterized by a body temp of 93-95 F and the victim will have uncontrollable shivering (this is the body’s attempt at rewarming).

The next couple of stages gradually have the person acting lethargic and listless. Their temps at these stages run from 85-92 F and there have been studies done which show that survival rates plummet when core temps are below 89 F. The skin will be blue-tinged and the victim may be unresponsive. In at traumatic injury situation, it’s ultimately important to know and understand the signs, symptoms and treatment of hemorrhagic shock, as well.

Getting the victim what they need (whole blood, packed red cells, etc.) is imperative as that is what they’ve lost. The sooner they’re aggressively treated, the better. Even if treatment is aggressive, they can still develop life-threatening complications like DIC (Disseminated Intravascular Coagulation), SIRS (Systemic Inflammatory Response Syndrome) and ARDS (Adult Respiratory Distress Syndrome) and die.

For us at the roadside, what can we do to help? STOP THE BLEEDING, START THE BREATHING! Keep them warm, keep talking with them. Use that mylar blanket in your kit. Use your jacket and pad underneath them and turn them into a “Trauma Taco” and pray that EMS arrives quickly.
Keep it safe. Keep it simple.

-Pocket Doc