CEN review

Trauma Triad Of Death

💉🚑🚑💉💉🚑🚑💉💉🚑🚑🚑🚑 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. •


Hypovolemic shock secondary to hemorrhage produces a lethal triad


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 “shocky” 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.

CEN Review Question

answer: C. Remember the epidural bleeds are a tear of the middle meningeal artery, which is located in temporal lobe. The biggest clue is location AND pt presentation. The pt has a period of lucidity, and then falls into a decreased LOC after “they appear fine” right after the incident. Case in point, Natasha Richardson’s skiing accident proved fatal after she fell, struck her head (no helmet) and did not go to the ED to get a scan. Sadly, she died from her epidural bleed.