Citation: Aghababaeian H, et al. Lack of Attention to Oxygen Temperature in the Ambulance during Treatment of ICP and Head Trauma: The Silent Killer. Ann Med Health Sci Res. 2017; 7: 99-100

This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http://creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact reprints@pulsus.com

Letter to Editor

Traumatic Brain Injuries (TBI) is a major burden on the health care system in the world. Approximately 10 million TBIs occur annually. [1] In addition, patients who survive these injuries may be disabled forever. [2,3] Remedial action for trauma patients begins with Advanced Trauma Life Support (ATLS) and attempts to immediately treat life-threatening injuries, such as airway obstruction, inadequate oxygen supply and shock etc. based on ABCs algorithm. The main priority for pre-hospital careers is ensuring an open airway and acceptable respiratory status as hypoxia is the most immediate threat to life. [4-6] However, the prognosis of patients is closely related to primary and urgent actions, [7] such that disorder in the prognosis of patients with brain injuries is highly associated with pre-hospital secondary problems. Most of these problems can be resolved by studying these problems and changing the process of prehospital care. [2,3]

Hypoxia generally occurs whilst transferring TBI patients. Emergency technicians are forced to deliver oxygen treatment to reduce hypoxia - some studies have reported that timely oxygen therapy and correct hyperventilation of TBI patients can lower the rate of mortality by up to 7 times. [8] Applying oxygen and hyperventilation of some patients with high Intracranial Pressure (ICP) reduces PaCO₂ and cerebral vasoconstriction and decreases cerebral perfusion ICP. [9] The use of cooling blankets in some pre-hospital emergencies to reduce metabolism subsequently reduces ICP in trauma patients.

However evidence from researchers working in emergency rooms suggests an issue which could be addressed by prehospital personnel. In hot climates such as in Iran, where temperatures in some places reach 55° C, the temperature within enclosed metal ambulance cabins can climb even higher, as can the temperature of the oxygen manometer tank water, which is embedded in the rear cabin. The oxygen going out of the mask or nasal cannula is then warmer than the patient’s body temperature and the conscious or unconscious patient must ingest oxygen at uncomfortable and dangerously high temperatures. For every 1°C increase in body temperature, metabolism rises by 10% - 13% and pulse rises about 13%. In the pre-hospital ambulance TBI requires metabolism reduction and oxygen therapy to reduce hypoxia and prevent increased ICP, however, consider the TBI patient who faces increased ICP receiving high temperature oxygen in the back of a pre-hospital ambulance. It would seem to cause an increase in morbidity and mortality in patients with TBI. In conclusion, the researchers of this paper believe that this complication in pre-hospital care is a silent killer, of which no mention has been made, and for which no solutions are being considered.

Conflict of Interest

All authors disclose that there was no conflict of interest.

REFERENCES

1. Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G, Kobusingye OC. The impact of traumatic brain injuries: A global perspective. Neuro Rehabil. 2007; 22: 341-353.
2. Myburgh JA, Cooper DJ, Finfer SR, Venkatesh B, Jones D, Higgins A, et al. Australasian Traumatic Brain Injury Study (ATBIS) Investigators for the Australian; New Zealand Intensive Care Society Clinical Trials Group. Epidemiology and 12-month outcomes from traumatic brain injury in australia and new zealand. J Trauma. 2008; 64: 854-862.
3. Wu X, Hu J, Zhuo L, Fu C, Hui G, Wang Y, et al. Epidemiology of traumatic brain injury in eastern China, 2004: A prospective large case study. J Trauma. 2008; 64: 1313-1319.
4. Dutton RP. Anesthesia for Trauma. In Miller. Rd Etal. Miller, S Anestesia (eds). New York: Churchil Living Gestone; 2009: 2777-2312
5. Emergency Medical Services Pre-Hospital Statewide Treatment Protocols. Available From: www.mass.gov/eohhs/docs/dph/emergency-services/treatment-protocols-2016.pdf
6. National Model EMS Clinical Guidelines. AVAILABLE FROM: https://nasemso.org/Projects/ModelEMSClinicalGuidelines/documents/National-Model-EMS-Clinical-Guidelines-Aug 2016.pdf
7. Mayglothling J, Duane TM, Gibbs M, McCunn M, Legome E, Eastman AL, et al. Emergency tracheal intubation immediately following traumatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. Journal of Trauma and Acute Care Surgery. 2012; 73: S333-S340.
8. Mayer TA, Walker ML. Pediatric head injury: the critical role of the emergency physician. Ann Emerg Med. 1985; 14: 1178-1184.
9.  Stocchetti N, Maas AI, Chieregato A, van der Plas AA. Hyperventilation in head injury: a review. Chest 2005; 127: 1812-1827.