Cold environment at the scene, during transport, in radiology, and in the ER.
Exposing the patient’s skin at the scene, in the ER and in the OR.
Cold operating room. The US Army suggest an operating room temperature of 110 degrees. I kid you not.
On going loss of warm blood/urine.
Evaporation of water from open cavities and owing to the patient’s humidification of dry ventilation gases.
Rapid infusions of cold crystalloids, blood, and blood products.
Coagulopathy (APTT greater than 60 seconds):
Loss of clotting factors from hemorrhage.
Dilution of clotting factor by infusion of crystalloid and packed red blood cells.
Inhibition of the clotting cascade by hypothermia.
Acidosis (pH less than 7.1):
Hypoperfusion due to hypovolemia.