Complex Trauma Case - Dr. King

- Hypothermia: Can cause significant physiologic disturbance, generally starting when body temperatures fall beneath 90 degrees (moderate hypothermia).  Moderate hypothermia should be aggressively corrected with both external and internal warming measures.  Risk of refractory VFIB increases as you approach 82.4degrees.  

- Severe hypothermia requires invasive rewarming techniques including invasive catheters (think therapeutic hypothermia in reverse).  This can include hemodialysis and ECMO. 

- Peri-intubation hypothermia:  associated with increased risk of mortality as well as increased ICU and hospital length of stay. Take steps to avoid it!  Think ketamine, fluids, pressors.  

- Spinal shock: sudden vasoplegia caused by loss of output from sympathetic system.  Classic presentation of hypotension and bradycardia is seen in less than 25% of cases.   Most recent guidelines recommend norepinephrine as pressor of choice.  Seen mostly commonly in injuries above T6.  

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