I hope everyone is safe, warm, and healthy. The picture above is from the recent snowstorm in the Northeast, shown under GNU Free Documentation License, from Wikipedia.
Say a patient is pulled out of the vehicle above. She is brought to the emergency department, minimally responsive with a core temperature of 30 degrees. Her hematocrit is 36 (reference range 35.4-44.4). Her finger stick glucose is elevated to 200, and she is given insulin. From the extraction, she has some cuts and abrasions that continue to bleed. Despite a normal PT, PTT, and INR, you consider giving her clotting factors.
Challenge: Are you worried about the hematocrit? Tell me about the insulin. And would you give her some FFP?
Is it cold-induced platelet dysfunction? the glucose measurement is high due to elevated stress hormones such as glucagon..
ReplyDeleteno FFP as the problem might be due to platelets function, so vitamin K or platelet transfusion maybe?
good ideas - temperature causes dysregulation of so many homeostatic mechanisms. this is what I thought:
ReplyDelete-
Nemo
Hematocrit increases 2% for each 1 degree drop in temperature, so a low normal hematocrit is concerning. Insulin does not work below 30 degrees Celcius. And coagulation labs are typically normal in a cold patient because the lab runs them at 37 degrees. Warming the patient will correct the bleeding; coagulation factors will not help.
Source: UpToDate.