@article{ref1,
title="Expeditionary immersion circulating heating device: a promising technique for treating frostbite injuries and warming intravenous fluids in a forward deployed cold weather environment",
journal="Military medicine",
year="2020",
author="Vinceslio, Eric M. and Fayos, Zane and Bernadette, Aaron and Van Gent, Jan-Michael",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="INTRODUCTION: Cold weather injuries require prompt warm water immersion therapy, which proves to be a difficult task in the cold austere environment. Current guidelines recommend 104 °F water immersion, but producing and maintaining large volumes of warm water is challenging in sub-freezing temperatures. We describe a novel process of utilizing a sous vide immersion circulator to maintain warm fluids for immersion therapy and efficient fluid rewarming in a cold forward-deployed setting for the treatment of cold weather injuries in an effort to bridge the gap between current medical guidelines and practices.   MATERIALS AND METHODS: Large water cans were warmed to 104 °F with the immersion circulator. A thermometer was inserted into a 1-inch steak, frozen to 30 °F, and placed in a basin with only the warmed water while the internal temperature was monitored until physiologic temperature was achieved. The time to this endpoint was recorded. A 1-L bag of normal saline and a 450-mL bag of whole blood were also separately warmed by the same technique. The temperature of the normal saline was monitored at 0-, 5-, 7-, 8-, 9-, and 10 -minute intervals. The process was similarly repeated, measuring the whole blood temperature at 0-, 5-, 7-, and 10-minute intervals.   RESULTS: Ambient internal tent temperatures averaged 54 °F; outdoor temperatures were consistently sub-freezing. The 5-gallon cans of water at ambient temperature heated to 104 °F in 15 minutes. The water temperature remained constant for 3 weeks with the circulator running. The frozen steak started at 30 °F and reached 98 °F in 52 minutes and 45 seconds. The bag of normal saline and whole blood, refrigerated to 39 °F, achieved temperatures of 102 °F and 94 °F respectively after 10 minutes.   CONCLUSION: A heating immersion circulator device is a lightweight, flameless, and inexpensive way to consistently heat large volumes of water for treatment of cold weather injuries, hypothermia, and whole blood rewarming in a cold austere environment.<p /> <p>Language: en</p>",
language="en",
issn="0026-4075",
doi="10.1093/milmed/usaa213",
url="http://dx.doi.org/10.1093/milmed/usaa213"
}