Trauma Triad Of Death

πŸ’‰πŸš‘πŸš‘πŸ’‰πŸ’‰πŸš‘πŸš‘πŸ’‰πŸ’‰πŸš‘πŸš‘πŸš‘πŸš‘ The lethal trauma triad of death is one of the things that increases trauma patients morbidity & mortality. By majority, the answer would be hypovolemic shock. Hypovolemia is defined as a state in which there is a decrease in plasma volume within the body. Hypovolemia, if severe enough, produces shock. Shock is defined as inadequate tissue perfusion combined with the inadequate removal of cellular wastes, ultimately producing a defect in oxidative metabolism and therefore a subsequent dysfunction in the way that the body transports, delivers, and utilized oxygen. Hypovolemic shock in trauma patients often stems from acute hemorrhage. β€’

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Hypovolemic shock secondary to hemorrhage produces a lethal triad

of:

1.) acidosis

2.) hypothermia

3.) coagulopathy

Hypovolemic shock produces several defects in physiology. The decreased intravascular fluid volume decreases venous return to the heart, which ultimately reduces preload and stroke volume (SV). The body initially compensates for the decreased SV by increasing the heart rate in order to maintain cardiac output (CO). Eventually CO decreases and subsequently results in decreased end-organ perfusion.

As the body becomes deprived of oxygen, aerobic metabolism shifts to anaerobic metabolism. This shift causes the build up of lactic acid, which ultimately produces metabolic acidosis. The hemorrhage in hypovolemic shock results in extreme activation of prothrombin, which causes an excess of thrombin formation. The excess thrombin causes the conversion of fibrinogen to fibrin. Fibrin activation produces wide-spread clot formation. This process depletes coagulation factors. Overtime, secondary fibrinolysis and coagulopathy results in further bleeding. As the hemorrhage progresses, hypothermia results from excess shunting of blood away from extremities producing a β€œshocky” looking patient who is clamped down.

The patient usually has delayed cap refill and w/kids an early sign is a gap between central and peripheral pulses. Giving volume such as whole blood or 1:1:1 of PRBC’s/platelets/FFP is what the patient needs in order to achieve homeostasis, maintain normal perfusion and to hopefully achieve a MAP of 65.

About the Author
I am an experienced trauma nurse who has seen a lot of super tragic and gnarly things. On the flip side, I’ve have seen and done a lot of amazing things in my 20 years of nursing as well. I’ve saved lives for a living and I have had the privilege and the honor of holding patients hands as they take their last breath. I have seen SO many patients and their loved ones in their most fragile moments. I am proud of my profession, and for the fact that I have fought so valiantly to be here. Sometimes nurses get burnt out, but I have been blessed to be at the bedside all of my career. I have earned multiple degrees and certifications in nursing. I am the nurse you want at your bedside when you’re critically injured and dying. I put my blood, sweat and tears into being clinically astute & relevant. This blog is to help new nurses, nursing students, paramedics, experienced nurses, or whomever comes across my blogs path and think it is intriguing, educational or inspiring to them. In this career, we are all here to share and help one another grow. I believe in building others up, so they can reach the next level, whatever their goal may be. Carpe Diem & ENJOY!

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