Gastric POCUS, 3-Part Episode

Trauma resuscitation is challenging for a myriad of reasons, including hemodynamic control, airway management, and volume resuscitation. Temperature control is often ignored during these busy and chaotic times such that patients may be hypothermic upon admission to the hospital, which continues to worsen as they are uncovered and unwarmed for a variety of tests and interventions. Frequently, patients come to the operating room with significant hypothermia. In the operating room with induction of general anesthesia and large surface skin prepping for surgery, heat loss continues due to redistribution, radiation, convection, conduction and evaporation. Radiant heat lamps when used appropriately can help facilitate prevention of further heat loss during times when patients must be uncovered. They have the advantage of not having to come in direct contact with the patient, but they should be in close enough proximity to be effective. A heated circulating water mattress under the patient is fairly ineffective because the backside of the patient closest to the mattress actually loses very little heat, accounting for a small fraction of the total surface area. Most (90%) heat loss is from the anterior surface of the patient. It is important to provide warmed fluids when doing a large volume resuscitation but warmed fluids alone are unlikely to increase core temperature because it is unsafe to administer fluids warmer than 40°C. Fluid warmers do not substitute for an adequate cutaneous warming plan. Heated and humidified airway circuits do not contribute much to preservation of core body temperature in adults.