Question regarding warmer fluid

[marymetzzzzz]

Hi!

I'm thinking mostly about any case (adult or pediatric) that would end up in the trauma room (resus room). Can anyone think of a contraindication to using the fluid warmer for any fluid (or boluses) prescribed?

Thanks!

[Lunah, MSN, RN]

Heat injury? But generally warm fluids will help trauma patients from slipping into to that deadly hypothermia-acidosis-coagulopathy triad.

[marienm, RN, CCRN]

Pixie, if by heat injury you mean "burn," these patients get cold fast due to evaporative loss, even if it was a hot day. We definitely use warm fluids in the Burn ICU in addition to keeping the patient room at 95 degrees F. The ED begins fluid resuscitation with warmed fluids depending on core temp.

If you mean something more like "heat stroke" (trauma patient trapped in a vehicle for a long time on a hot day?) I would guess that a core temp should guide you. Our rapid infuser heats fluid to 41 celsius, I think...hot enough to make a high temp worse.

Mary, I see you work peds and I don't know whether therapeutic hypothermia is ever used for kids s/p cardiac arrest? For adults we would do it following an electrical injury that caused a cardiac arrest. This patient would come into the ED's trauma bay initially and I wouldn't expect the ED to start cooling the patient but it would help not to warm them.

My last speculative thought would be that hypothermia causes some degree of hypertension due to vasoconstriction...which is not helpful for long-term prognosis, but in some kind of extreme circumstances (battlefield?) delaying warmed fluids might help keep BP higher? But those extreme circumstances shouldn't exist in the trauma bay!