Earthquakes cause devastating effects, resulting in the deaths of thousands of people each year. Understanding the full range of impacts, including fatalities, and the pathophysiological mechanisms underlying these effects is crucial for mitigating the aftermath of earthquakes. Therefore, this review aims to: delineate the critical golden time periods following earthquakes and identify the most effective responses and resilience factors during these periods; accurately define the terminology for injuries sustained post-earthquake; elucidate the basic pathophysiology of CRUSH injury-induced myopathy, one of the most significant pathologies in post-earthquake patient management; explore the role of nitric oxide (NO) mechanisms in crush injuries, which are believed to be fundamental to the “smiling death phenomenon” and represent the unseen part of the iceberg; and highlight the importance of the 3 main phenomena responsible for mortality—acidosis, coagulopathy, and hypothermia—during disasters. This comprehensive review, based on the latest literature, encompasses search and rescue, pre-hospital processes, emergency department procedures, and subsequent internal and surgical management algorithms.

During the commercial slaughter of farmed turbot (Scophthalmus maximus), a total of 67 fish were, on six occasions, removed from their rearing conditions at 14°C and put, as is standard commercial practice, into chilled seawater (-1.5 to -0.8°C) to monitor behavioural, muscular, osmoregulatory and respiratory responses during chilling time (90 min). Results show that a thermal insult alters the iso-osmotic balance, leading not only to an Na+ influx and an intracellular release of Ca2+ and K+, but also to a disturbance of respiratory function, leading to acidosis as a result of H+ and CO2 accumulation, increased pCO2 and reduced HCO3− in the blood. Once the internal temperature dropped below 1°C, the muscles contracted (cold shortening) and, although the fish were still alive, they reverted to a state of rigor, leading to a complete breakdown in their ability to move or ventilate and resembling an unconscious condition or death. Remarkably, the fish were able to prevent themselves undergoing hypoxia as pO2 remained within acceptable limits. No changes in muscle pH were observed and, thus, no noted effects on textural properties. We conclude that live chilling from 14°C to approximately -1°C is a highly questionable practice. It causes physical and physiological changes that are generally associated with stress and, in the case of observed forced muscle contractions, could lead to severe pain. Furthermore, we conclude that cold shortening associated with chilling can be easily mistaken for rigor mortis and, as such, should be subject to further attention in future research on quality.

Capturing wild birds with mist nets is very common for studying many aspects of avian biology. However, except for adrenocortical reactivity, little is known about other physiological responses to this potentially stressful procedure. Here, we focused on body temperature (Tb) in migratory songbirds, as large numbers are caught for population monitoring and studies of migratory biology. Tb is sensitive to acute stress in other vertebrates and contexts, usually showing an increase (stress-induced hyperthermia). We sampled garden warblers (Sylvia borin), whinchats (Saxicola rubetra) and barn swallows (Hirundo rustica) captured with mist nests using standard protocols at an island stopover site in the central Mediterranean during spring migration. Tb was measured within 3 min (T0), 30 min (T30) and 180 min (T180) from the time the bird hit the net, using an analogue probe inserted into the throat, and a body condition score was calculated for each bird. In the garden warbler, but not the other two species, a slight but significant reduction in Tb occurred after 180 min. In all species, the change in Tb after 3 h of confinement was positively correlated to the change in ambient temperature (Ta) but not to body condition. The mean (± SEM) change in Tb over 3 h was −1.68 (± 0.16)°C for garden warblers, therefore within the expected range of normothermy in small birds. Such reduction in Tb is contrary to the expectation of stress-induced hyperthermia; these results suggest that garden warblers are able to modulate their body temperature and that these small changes are influenced by fluctuations in ambient temperature. Therefore, Tb might not be a good indicator of capture stress in small passerine migrants. Our results also indicate that restraint for ringing procedures is unlikely to have adverse effects on Tb regulation of migratory birds, if held within the time-frame typical of ringing operations.

Introduction: Hypothermia in severe trauma patients can increase mortality by 25%. Active re-warming decreases mortality and is recommended in trauma management guidelines. Despite this, many emergency medical services (EMS) vehicles do not carry equipment for active re-warming. This study sought to determine the local rate of hypothermia in major trauma patients on trauma centre arrival (TCA), and to establish which patients are at highest risk by identifying factors present in the pre-hospital setting associated with hypothermia in a humid continental climate. Methods: This single-centre retrospective chart review included adults (age 18) in the local trauma registry (trauma team activation or injury severity score >12) from January 2009-June 2016. Patients were excluded if: temperature on TCA unknown or 38°C, not transported by EMS, or if there was >24 hrs from injury to TCA. The primary outcome was the rate of hypothermia (<35°C) in major trauma patients transported by EMS on arrival at the local trauma centre. Secondary outcomes included hospital length of stay and survival to discharge. Logistic regression was used to identify predictors of hypothermia on TCA; it included the following factors: age, sex, weight, number of comorbidities, injury severity, injury mechanism, EMS modality, direct transport from scene or referred from peripheral hospital, time on scene, transport time, local temperature, and pre-hospital heart rate, systolic blood pressure (SBP), intubation, and volume of crystalloid. Results: A total of 3070 adult traumas were included, 159 of which were hypothermic on TCA a rate of 5%. Multivariate analysis identified seven risk factors for hypothermia: intubation pre-hospital (OR 8.10, p<0.001), blunt trauma (OR 3.37, p=0.044 vs. penetrating, and OR 7.35, p=0.023 vs. other), direct transport (OR 1.94, p=0.005), number of comorbidities (OR 1.14, p=0.036), injury severity (OR 1.03, p<0.001), 1°C local temperature drop (OR 1.03, p<0.001), and 1mmHg SBP drop (OR 1.01, p<0.001). Ninety-four percent of normothermic patients and 69.2% of hypothermic patients survived to discharge. Average length of stay was 7.98 and 15.23 days respectively. Conclusion: Avoidance of hypothermia is imperative to the management of major trauma patients. Those at highest risk in a humid continental climate are severely injured blunt trauma patients with multiple co-morbidities, a low pre-hospital SBP and EMS intubation. Future studies should focus on the benefits of pre-hospital rewarming in these high-risk patients.

Accidental hypothermia can lead to untoward cardiac manifestations and arrest. This report presents a case series of severe accidental hypothermia with cardiac complications in three emergency patients who were treated with extracorporeal membrane oxygenation (ECMO) and survived after re-warming. The aim of this discussion was to encourage more clinicians to consider ECMO as a re-warming therapy for severe hypothermia with circulatory collapse and to prompt discussion about decreasing the barriers to its use.

NiehausMT, PechulisRM, WuJK, FreiS, HongJJ, SandhuRS, GreenbergMR. Extracorporeal Membrane Oxygenation (ECMO) for Hypothermic Cardiac Deterioration: A Case Series. Prehosp Disaster Med. 2016;31(5):570–571.

It has been documented that floor heating of the farrowing area in loose housed sows improves survival of piglets significantly. However, today, the majority of farrowing pens are designed with crating of sows and slatted floor at the birth site. The aim of this study was to investigate whether providing radiant heat at the birth site to new-born piglets in pens with crated sows reduced hypothermia, time to first milk intake and growth of the piglets during the 1st week. Second parity Danish Landrace×Yorkshire sows (n=36) were randomly divided into two groups: Control (CG) and heat (HG). In the area behind the sow (zone 1), two radiant heat panels were mounted above the slatted floor in the HG. The farrowings were attended, and the heaters were turned on at birth of first piglet and turned off 12 h after. Birth time, time to leave zone 1, time to first contact with udder and time to first suckling were registered by direct observation. The piglet’s rectal temperature (RT) was measured 15, 30, 60, 120, 180, 240 min after birth and 12, 14 and 24 h after birth of first piglet. Piglets were weighed at birth, 24 and 48 h and 7 days after birth. Data were analysed in a mixed model in SAS. The drop in RT was lower in HG compared with CG (P=0.002), and the RT in HG remained higher than in CG from 30 to 240 min after birth (P<0.05), whereas no difference was found at 12 h after birth of first piglet (P=0.92). Piglets in HG stayed longer in zone 1 than those in CG (P=0.01), whereas time to reach udder (P=0.35) and to first suckling (P=0.56) did not differ. No difference in weight gain was found between piglets in HG and CG at 24 h (P=0.23), 48 h (P=0.28) and 7 days after birth (P=0.44). Birth weight had a positive effect on RT (P<0.001) and reduced time to leave zone 1 (P<0.01), reach udder (P<0.001) and time to first suckling (P<0.001). The results showed that radiant heating behind the sows reduced hypothermia in new-born piglets and indicate that providing heat during the first half hour after birth is important.

The effects of early life events on average daily weight gain from birth to day 21 (ADG) of suckling pigs kept at different room temperatures (15°C, 20°C and 25°C) from birth to weaning were investigated. Data were collected from litters born by 61 sows in a loose housing system. The ADG for piglets with low birth weight (estimated for birth weights below the 10% percentile) was estimated to be 20 to 30 g higher per day at room temperature 20°C to 25°C compared with 15°C. In contrast, the ADG during the lactation period decreased for larger piglets (estimated for birth weights above the 10% percentile) by 28 g/day at room temperature 25°C compared with 15°C. Thus, high ambient temperatures (20°C to 25°C) are favourable for the growth in smaller piglets during lactation. Neither latency to first suckle nor birth-induced hypoxia, measured as concentration of umbilical cord lactate, affected the growth rate of the piglets. Lowest rectal temperature during the first 24 h after birth had a long-term negative effect on ADG (P<0.05), so that piglets with a lowest rectal temperature of 32.8°C (10% percentile) had an ADG which was on average 19 g lower per day than piglets with a rectal temperature of 37.3°C (90% percentile). Our results showed that hypothermia at birth, low birth weight and high number of suckling piglets lead to reduced ADG during the suckling period. The results suggest that keeping the room temperature at 20°C during lactation to some extent could compensate for the otherwise negative effects of low birth weight on ADG in piglets without decreasing the ADG of high birth weight piglets. However, to avoid hypothermia in the smallest piglets it may be beneficial to increase the room temperature above 20°C during the farrowing period of loose housed sows.

Background: Our goal was to perform a systematic review of the literature on the use of therapeutic hypothermia for refractory status epilepticus (RSE) and its impact on seizure control. Methods: All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to May 2014), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated by two independent reviewers, using both the Oxford and GRADE methodology. Results: Overall, 13 studies were identified, with 10 manuscripts and 3 meeting abstracts. A total of 40 patients were treated. The common target temperature was 33 degrees Celsius, sustained for a median 48 hours. Patients displayed a 62.5%, 15% and 22.5% rate of seizure cessation, seizure reduction, and failure of treatment respectively. External cooling was utilized in the majority of cases. Deep venous thrombosis, coagulopathy and infections were the commonly reported complications. Two ongoing clinical trials were identified. Conclusions: Oxford level 4, GRADE D evidence exists to support the use of therapeutic hypothermia to control seizures in RSE. Further prospective study is warranted.