Trauma triad of death

A critical condition in trauma patients

Overview

The trauma triad of death is a medical term describing the combination of three conditions that often occur in patients who have sustained severe traumatic injuries. These conditions are hypothermia, acidosis, and coagulopathy. The triad is a vicious cycle that can lead to a significant increase in mortality if not promptly recognized and treated.

Diagram illustrating the trauma triad of death

Components

Hypothermia

Hypothermia is a condition where the body loses heat faster than it can produce it, causing a dangerously low body temperature. In trauma patients, hypothermia can result from exposure, blood loss, and the administration of cold intravenous fluids. Hypothermia impairs the body's ability to clot blood, exacerbating bleeding.

Acidosis

Acidosis refers to an excess of acid in the body fluids. In the context of trauma, it is often due to lactic acidosis, which occurs when the body is deprived of adequate oxygen, leading to anaerobic metabolism. Acidosis can impair cardiac function and further disrupt the coagulation cascade, worsening bleeding.

Coagulopathy

Coagulopathy is a condition where the blood's ability to clot is impaired. This can be due to dilution of clotting factors, hypothermia, and acidosis. Coagulopathy leads to uncontrolled bleeding, which can further exacerbate hypothermia and acidosis, creating a deadly cycle.

Pathophysiology

The trauma triad of death is a self-perpetuating cycle. As a patient becomes hypothermic, the enzymatic processes involved in coagulation become less efficient, leading to coagulopathy. The resulting bleeding can cause further hypothermia and acidosis. Acidosis, in turn, impairs cardiac function and further disrupts coagulation, leading to more bleeding.

Management

Effective management of the trauma triad of death involves rapid identification and correction of each component. This includes:

• Actively warming the patient to prevent or treat hypothermia.
• Administering warmed intravenous fluids and blood products.
• Correcting acidosis through adequate oxygenation and ventilation.
• Using blood products and medications to address coagulopathy.

Prevention

Preventing the trauma triad of death involves early recognition and intervention in trauma patients. This includes maintaining normothermia, ensuring adequate perfusion and oxygenation, and using damage control resuscitation techniques to minimize blood loss and coagulopathy.

Related pages

• Trauma surgery
• Hemorrhagic shock
• Damage control resuscitation
• Massive transfusion protocol