Réchauffer ACTIVEMENT le blessé sédaté
Un article à lire
Background Hypothermia at hospital admission has been found to independently predict increased mortality in trauma patients. Objectives To establish if patients anaesthetised in the prehospital phase of care had a higher rate of hypothermia than non-anaesthetised patients on admission to hospital. Methods Retrospective review of admission body temperature in 1292 consecutive prehospital trauma patients attended by a physician-led prehospital trauma service admitted to The Royal London Hospital between 1 July 2005 and 31 December 2008. Results 38% had a temperature recorded on admission. There was a significant difference in body temperature between the anaesthetised group (N=207) and the non-anaesthetised group (N=287): mean (SD) 35.0 (2.1) vs 36.2 (1.0)°C, respectively (p<0.001). No significant seasonal body temperature variation was demonstrated. Conclusion This study confirmed that patients anaesthetised in the prehospital phase of care had a significantly lower admission body temperature. This has led to a change in the author's prehospital practice. Anaesthetised patients are now actively surface heated and have whole body insulation to prevent further heat loss in an attempt to conserve body temperature and improve outcome. This is an example of best in-hospital anaesthetic practice being carried out in the prehospital phase.
Le recours à l'association Ready Heat Blanket II, Blizzard Blanket et charlotte thermolite est impératif en cas de sédation préhospitalière (Voir ici). La prudence est de mise en cas d'hypothermie sévère sans frissons (voir ici). On rappelle simplement l'importance de prévenir l'installation de la triade hypoxie/coagulopathie/acidose lors de la prise en charge d'un blessé choqué hémorragique (Voir ici)