In the severely injured patient, unless the lethal triad of hypothermia, acidosis, and. Ventilate the trauma patient with o2, keep them warm to promote cellular oxygenation and much of the problems with acidosis can be averted. The mean iss among patients with and without the lethal triad was 31. This study aimed to describe the presentation, management and outcome of. No death was recorded among the 74 patients without the lethal triad. Death in multiple trauma mt patients is one of the serious concerns of the medical service provider. Putting a stop to exsanguination the lancet haematology.
A short on the pathophysiology of the lethal triad of trauma. Review open access relevance of induced and accidental. Acidosis coagulopathy hypothermia acidosis shock state tissue hypoperfusion and hypoxia physiologic and proinflammatory disruption resulting coagulopathy hypothermia mortality is increased in trauma patients with temperatures below 32c lethal triad. He seemed a bit impressed i would even cover traumas deadly triad, in a first aid course. Lessons in transport the lethal triad december 02, 20 ryan gerecht, md. There is much to discuss, so this will be a multiepisode affair. Damage control resuscitation col tim lowes mbbs frca ficm dip imc rcsed lramc. Dilutional coagulopathy occurs when we resuscitate a bleeding trauma patient with fluid or blood products that dont contain the same clotting factors lost in the acutely hemorrhaged whole blood. This report will focus on the role of hypothermia a third of the lethal triad in trauma, examining literature to assess how prehospital temperature control can impact on the trauma patient. Although trauma care has come a long way over the past 30 years, trauma is still one of the leading causes of death in any age group, writes ryan gerecht, md, cmte in the april, 2014 issue of the journal of emergency medical services. Development of novel criteria of the lethal triad as an. Unitek emt studies the importance of combatting traumas. The lethal triad in trauma acidosis, hypothermia, and coagulopathy defines much of what i do in the icu and cardiothoracic ors.
Trauma resuscitation of the critically ill hemorrhagic. Trauma patients with the triad of death biswadev mitra,1,2 francesca tullio,1 peter a cameron,1,2 mark fitzgerald3 abstract introduction injured patients presenting with hypothermia, acidosis and coagulopathy have been identi. This study aimed to describe the presentation, management and outcome of major trauma patients presenting with the triad of death and identify ways to improve survival. The lethal triad consists of coagulopathy, hypothermia, and acidosis.
Traumatic injury is one of the leading causes of death, with uncontrolled hemorrhage. They feed off one another, such that bleeding begets more bleeding. Early and individualized goaldirected therapy for traumainduced coagulopathy early and individualized goaldirected therapy for traumainduced coagulopathy. Prognostic value of the lethal triad among patients with. This combination is commonly seen in patients who have sustained severe traumatic injuries and results in a significant rise in the mortality rate. However, there are a handful of relatively simply interventions that we can do to prevent our patients from entering the trauma triad of death. Neck trauma manage this in accordance with local protocols. A lethal triad of coagulopathy, acidosis, and hypothermia must all be addressed to provide adequate trauma resuscitation. Damage control resuscitation journal of intensive care biomed. To successfully resuscitate the critically ill trauma patient we must have an understanding of and a respect for the lethal triad of trauma. Traumas lethal triad penetrating chest traumas sirs sepsis burn trauma toxicology challenges cardiovascular neuro emergencies you have the daunting challenge of recognizing subtle changes in a patients condition that c. Accidental hypothermia as part of the lethal triad beside acidosis and coagulopathy, accidental hypothermia is recognised as one main pillar of the lethal triad after severe trauma 19,33. An open airway and oxygen administration also can help avoid the cascade of events involved in the trauma triad of death.
Investigation of frequency of the lethal triad and its 24 hours. These three factors both cause, and contribute to, acute coagulopathy of trauma shock acots which leads to, and result from, major hemorrhage. Rather than resulting from tissue trauma, or traumatic brain injury alone, this is. Anyway, he told me the second leading cause of death in a battlefield or was hypothermia, preceded only by exsanguination. Lethal triad had been implicated in not only killing our trauma and shock patients early, but contributes to the third peak or delayed deaths by sepsis, multiple organ dysfunction, dic, and ards. Hypothermia can occur secondary to blood loss, regardless. Damage control resuscitation transfusion guidelines. Request pdf on dec 1, 2015, nicola credland and others published managing the trauma patient presenting with the lethal triad find, read and cite all the research you need on researchgate. Volume management and resuscitation in trauma pdf paperity. The triad is one of the most important concepts of trauma and shock in general management and our understanding of it and two of its components impact on binding of o2 to hemaglobin, gives us more critical thinking tools when things are not going right. To evaluate the utility of the conventional lethal triad in current trauma care practice and to develop novel criteria as indicators of treatment strategy. For severely injured bleeding patients the extreme form may be characterised as the lethal triad of trauma with acidosis, hypothermia and coagulopathy with a.
In total, 796 consecutive trauma patients who were admitted to emergency departments with an. This is one of my favorite podcasts on the lethal triad and i have shared it with dozens in the past. Managing the trauma patient presenting with the lethal triad. Current management of massive hemorrhage in trauma. A common cause of death in patients with traumatic injuries is what gerecht terms the lethal triad of hypothermia, acidosis, and. If you do not see its contents the file may be temporarily. However, if early management regimes of permissive hypotension, highflow oxygen and administration of tranexamic acid are applied, mortality risk can be reduced significantly.
Lessons in transport the lethal triad taming the sru. Participants will learn new medical and trauma skills including the glasgow coma scale, lethal triad, vital signs, triage, burns, fractures, and more. Trauma is the leading cause of death for people in the uk and north america, especially for those aged 1524 years. Introduction injured patients presenting with hypothermia, acidosis and coagulopathy have been identified at high risk of death. The trauma triad of death is a medical term describing the combination of hypothermia, acidosis and coagulopathy. Advanced practice nursing essentials for role development, 4e. Alternatively, you can download the file locally and open with any standalone pdf.
Bleeding causes acidosis, coagulopathy, and hypothermia. Trauma and massive transfusion are associated with coagulopathy secondary to tissue injury, hypoperfusion, dilution and consumption of clotting factors and platelets and coagulopathy, together with hypothermia and acidosis, forms a lethal triad. Management of traumainduced coagulopathy in a severe blunt trauma patient. Its association with hypothermia and metabolic acidosis is common and constitutes a vicious cycle, causing a lethal triad. Its important to appreciate the interplay between these three derangements, anticipate problems, and intervene quickly. A digital version of this call publication is available to view or download from the call website. A repeat of these labs in the morning will be determined on a patient by patient basis. The lethal triad of trauma is a culmination of coagulopathy, acidosis, and hypothermia that can rapidly deteriorate and lead to a patients demise if not treated accordingly. Thought wed talk about some trauma stuff, specifically the resuscitation of the critically ill hemorrhagic shock patient. The lethal triad is a form of vicious cycle, which unless broken will result in death. Coagulopathy is a life threatening complication in trauma patients who have sustained significant injuries and blood loss. Pdf investigation of frequency of the lethal triad and its 24 hours. Guidelines for the institution of damage control in trauma patients pdf, itaccs.
Mortality rates for trauma patients in the triad of death range from 50% to 90% not good. Participants will also use various evacuation skills and tools to rapidly move patients to a safer location. Hemorrhage requiring massive transfusion remains a major cause of potentially preventable deaths. Trauma patients with the triad of death request pdf researchgate. Today, well concentrate on the lethal triad and bp goals. Fifteen acute critical care medical centers in japan. Previous trauma care class is required for this course, see below.
Msf mokha hospital the lethal triad of trauma materials from the jems article. The lethal triad is the path the decompensating patient follows on the progression towards shock and death. Management of traumainduced coagulopathy in a severe blunt trauma patient jeanstephane david, m. The trauma triad of death is a medical term describing the combination of hypothermia, acidosis. These patients presented directly from the scene, were coagulopathic international normalised ratio inr 1. The coagulopathy associated with haemorrhagic shock, which complicates major trauma, is a common scenario and a difficult challenge. Hypothermia, acidosis, and coagulopathy constitute the lethal triad in trauma patients. Lethal triad in order to understand the complexities of the resuscitation in a bleeding trauma patient, we must become familiar with the lethal triad. Prevent the lethal triad hypothermia, coagulopathy, acidosis temperature 37 degrees. Bleeding causes acidosis, hypothermia, and coagulopathy. Commonly, when someone presents with these signs, damage control surgery is employed to reverse the effects.