Even with significant advancements in acute medicine and traumatology over the last thirty years, trauma remains a leading cause of death, especially among younger individuals. Hemorrhage, which can be prevented with proper first aid and treatment, is a common cause of these deaths. Hypothermia, acidosis, and coagulopathy are critical factors and just as important as surgical intervention for managing injuries.

Pathophysiology of severe trauma

Severe trauma leads to extensive tissue damage and increased blood loss, which reduces oxygen supply and forces cells into anaerobic metabolism, where lactic acid production increases. This lowers the pH level and leads to acidosis, even with normal or slightly affected vital parameters.

Acidosis and coagulation

Acidosis affects the blood's clotting ability, which can be halved with a pH drop from 7.4 to 7.0, increasing the risk of further bleeding and worsening the patient's condition. Hypoventilation due to, among other things, narcotics or trauma can further exacerbate this condition.

Hypothermia in trauma

In shock, the body restricts blood flow to the extremities to maintain vital organ function, which can lead to hypothermia due to several heat-losing factors. These include blood volume loss, heat loss to the surroundings, and from increased respiration, which also impairs the blood's clotting ability.

Effect of fluid therapy

The use of isotonic NaCl in large quantities can worsen both hypothermia and the blood's clotting ability if the fluid is not warmed, as it dilutes coagulation factors in the blood.

The trauma triad of death spiral

This lethal combination of hypothermia, acidosis, and coagulopathy, known as the "trauma triad of death spiral," exacerbates each other without proper treatment, putting the patient at high risk of death.

Source:

Akuttundervisnings kompendium i akuttundersøkelse v1.0, 2023.

https://akutsygepleje.org/trauma-triad-of-death-en-doedelig-cyklus/

Chatrath V, Khetarpal R, Ahuja J. Fluid management in patients with trauma: Restrictive versus liberal approach. J Anaesthesiol Clin Pharmacol. Published online 2015:308. doi:10.4103/0970-9185.161664