Trauma triad of death

A combination of three conditions that often occur together in trauma patients

Diagram illustrating the trauma triad of death

The trauma triad of death is a combination of three conditions that often occur together in patients who have sustained severe traumatic injuries. These conditions are hypothermia, acidosis, and coagulopathy. The presence of these three factors can significantly increase the risk of mortality in trauma patients.

Components

Hypothermia

Hypothermia is a condition where the body loses heat faster than it can produce it, leading to a dangerously low body temperature. In the context of trauma, hypothermia can occur due to exposure, blood loss, and the administration of cold intravenous fluids. Hypothermia can impair the body's ability to clot blood, exacerbating bleeding.

Acidosis

Acidosis refers to an excess of acid in the body fluids. In trauma patients, acidosis is often caused by inadequate tissue perfusion and oxygenation, leading to anaerobic metabolism and the accumulation of lactic acid. Acidosis can further impair cardiac function and reduce the effectiveness of coagulation.

Coagulopathy

Coagulopathy is a condition where the blood's ability to clot is impaired. In trauma patients, coagulopathy can result from massive blood loss, dilution of clotting factors due to fluid resuscitation, and the effects of hypothermia and acidosis. Coagulopathy can lead to uncontrolled bleeding and is a major contributor to mortality in trauma patients.

Pathophysiology

The trauma triad of death is a vicious cycle where each component exacerbates the others. Hypothermia can lead to coagulopathy by impairing platelet function and the enzymatic processes involved in coagulation. Acidosis can further impair coagulation and reduce cardiac output, worsening hypothermia. Coagulopathy leads to increased bleeding, which can cause further hypothermia and acidosis.

Management

Effective management of the trauma triad of death involves addressing each component simultaneously. This includes:

• Actively warming the patient to prevent or treat hypothermia.
• Administering blood products and clotting factors to correct coagulopathy.
• Ensuring adequate oxygenation and perfusion to prevent or treat acidosis.

Rapid surgical intervention to control bleeding and minimize further blood loss is also critical.

Related pages

• Trauma surgery
• Hemorrhagic shock
• Resuscitation