Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update

Dow, Jamie; Giesbrecht, Gordon G.; Danzl, Daniel F.; Brugger, Hermann; Sagalyn, Emily B.; Walpoth, Beat H.; Auerbach, Paul S.; McIntosh, Scott; Némethy, Mária; McDevitt, Marion; Schoene, Robert B.; Rodway, George W.; Hackett, Peter H.; Zafren, Ken; Bennett, Brad L.; Grissom, Colin K.

doi:10.1016/j.wem.2019.10.002

Cited by 73 publications

(149 citation statements)

References 127 publications

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“…The temperature change from warm intravenous fluids on morbidly obese patients appears minimal. During profound hypothermia, shock states, and vasopressor infusion, there may be relative vasoconstriction of the extremities, which was modeled in this study (Dow et al, 2019). Although large-volume iced fluid infusions have been reported without adverse effects, extreme caution should be maintained since sudden cardiac temperature change may result in dysrhythmia (Jacobshagen et al, 2009).…”

Section: Discussionmentioning

confidence: 97%

“…Multiple methods for body temperature modification exist such as ice packs, central venous countercurrent devices, forced-air warming blankets, evaporative cooling, cold water immersion, peritoneal lavage, and extracorporeal membrane oxygenation (Hilmo et al, 2014;Kempainen and Brunette, 2004;Truhlář et al, 2015;Dow et al, 2019;Epstein and Yanovich, 2019). A temperature modification technique available at nearly all emergency and inpatient settings is intravenous fluid bolus of lactated Ringers solution or physiological saline.…”

Section: Introductionmentioning

confidence: 99%

“…A temperature modification technique available at nearly all emergency and inpatient settings is intravenous fluid bolus of lactated Ringers solution or physiological saline. Guidelines for resuscitating hypothermic or hyperthermic patients include heated or cooled intravenous fluids, and warmed (40°C-42°C) intravenous fluids are an evidence grade 1B recommendation for hypothermic resuscitation (Truhlář et al, 2015;Dow et al, 2019). This study seeks to approximate the change in body temperature for a given volume of chilled or heated isotonic crystalloid bolus; utilizing this information, clinicians may estimate the dose-response of fluids for treatment of abnormal body temperature.…”

Section: Introductionmentioning

confidence: 99%

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Dosing Heat: Expected Core Temperature Change with Warmed or Cooled Intravenous Fluids

Blumenberg

2021

Therapeutic Hypothermia and Temperature Management

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Emergent modification of a patient's body temperature is crucial in certain disease or injury states. Advanced targeted temperature management techniques such as central venous catheter devices are not universally available, however, virtually all medical centers have access to intravenous fluids. This study approximates the change in body temperature for a given volume of room temperature, chilled, or heated isotonic crystalloid bolus. Using thermodynamic principles, a mathematical model was created to approximate change in body core temperature in response to a given volume and temperature of intravenous fluid. The model assumes rapid fluid infusion and the previously published specific heat capacity of the human body of 3.47 J/kg $°C. Values were calculated under conditions of varying body temperatures from profound hypothermia to hyperthermia (18°C-45°C). Various crystalloid temperatures representing iced, room temperature, and warmed (4°C, 20°C, 42°C) were used in the calculations. Each 30 mL/kg dose of 20°C crystalloid is expected to cool a hyperthermic (38°C-45°C) patient by 0.6°C-0.9°C. Each 30 mL/kg dose of 4°C crystalloid is expected to cool a hyperthermic (38°C-45°C) patient by 1.2°C-1.4°C. Each dose of 42°C crystalloid is expected to warm a hypothermic patient by 0.2°C-0.8°C. Using the results in this study, clinicians may roughly estimate the effect of temperature management with varying doses of intravenous fluids and thus assess the benefits of this technique. Risk should be evaluated based on inevitable coadministered volume and electrolytes. Individuals with volume-sensitive conditions such as heart, liver, or kidney failure deserve particular attention. Based on a mathematical model, typical expected core temperature change is about 0.2°C-1.4°C per 30 mL/kg crystalloid bolus, depending on patient and fluid temperature.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dosing Heat: Expected Core Temperature Change with Warmed or Cooled Intravenous Fluids

Blumenberg

2021

Therapeutic Hypothermia and Temperature Management

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“…It is important to recognize that patients have recovered from exceptionally low core temperatures in cardiac arrest, and that resuscitation attempts should be undertaken and continued regardless of measured core temperature. The lowest temperature from which hypothermic humans can be resuscitated is not known, and the idea that any temperature equates to “obvious death” is mythical (Dow et al 2019). It is the case that unconscious patients should be handled gently to prevent ventricular fibrillation (a nonsustaining heart arrhythmia), but if a patient in this situation does lose a pulse due to this, management should be the same as any other hypothermic cardiac arrest.…”

Section: Myth 6: Cpr Mythsmentioning

confidence: 99%

Ten Myths about Medical Emergencies and Medical Kits

Hawkins

Simon²

2021

Adv. archaeol. pract.

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Wilderness medicine is plagued by myths and dogmatic teachings not supported by evidence. This article focuses particularly on those teachings and tools that would be most likely used in archaeological fieldwork. It lays out 10 of the most common and concerning myths taught in wilderness medicine and wilderness emergency medical services, both in terms of first aid and preparation of medical kits. The myths described are provide a structure for the main purpose of the article: to explain interventions and medical kit contents that are more evidence based and supported by modern understandings of wilderness medicine and fieldwork risk management. The list of top 10 myths includes (1) the use of medications other than epinephrine for anaphylaxis and (2) the availability and proper use of epinephrine auto-injectors, (3) the use of suction devices and tourniquets for snakebites, (4) the use of spinal immobilization for neck injuries, (5) the identification and treatment of heat illnesses, (6) the use of CPR in remote areas, (7) the appropriateness of dislocation reduction in remote areas, (8) the use and choice of tourniquets for arterial bleeding, (9) the initial definition and management of drowning patients, and (10) wound management myths.

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“…It is not clear whether wet clothes should be removed before applying a tightly fitting vapour barrier [204,205]. Wilderness Medical Society guidelines suggest cutting off wet clothing when a vapour barrier is not available or when the patient is at high risk of continued cooling [206]. The use of a vapour barrier, non-breathable waterproof material, to reduce evapourative and convective heat loss, is most effective when the vapour barrier, made of thick material or containing trapped air, (e.g.…”

Section: Hypothermia and Temperature Managementmentioning

confidence: 99%

Multiple trauma management in mountain environments - a scoping review

Sumann¹,

Moens

Brink

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background Multiple trauma in mountain environments may be associated with increased morbidity and mortality compared to urban environments. Objective To provide evidence based guidance to assist rescuers in multiple trauma management in mountain environments. Eligibility criteria All articles published on or before September 30th 2019, in all languages, were included. Articles were searched with predefined search terms. Sources of evidence PubMed, Cochrane Database of Systematic Reviews and hand searching of relevant studies from the reference list of included articles. Charting methods Evidence was searched according to clinically relevant topics and PICO questions. Results Two-hundred forty-seven articles met the inclusion criteria. Recommendations were developed and graded according to the evidence-grading system of the American College of Chest Physicians. The manuscript was initially written and discussed by the coauthors. Then it was presented to ICAR MedCom in draft and again in final form for discussion and internal peer review. Finally, in a face-to-face discussion within ICAR MedCom consensus was reached on October 11th 2019, at the ICAR fall meeting in Zakopane, Poland. Conclusions Multiple trauma management in mountain environments can be demanding. Safety of the rescuers and the victim has priority. A crABCDE approach, with haemorrhage control first, is central, followed by basic first aid, splinting, immobilisation, analgesia, and insulation. Time for on-site medical treatment must be balanced against the need for rapid transfer to a trauma centre and should be as short as possible. Reduced on-scene times may be achieved with helicopter rescue. Advanced diagnostics (e.g. ultrasound) may be used and treatment continued during transport.

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Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update

Cited by 73 publications

References 127 publications

Dosing Heat: Expected Core Temperature Change with Warmed or Cooled Intravenous Fluids

Dosing Heat: Expected Core Temperature Change with Warmed or Cooled Intravenous Fluids

Ten Myths about Medical Emergencies and Medical Kits

Multiple trauma management in mountain environments - a scoping review

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