Trauma Triad of Death

I was recently asked why we work so hard to keep trauma patients warm.

My answer is The Trauma Triad of Death.

From Wikipedia:

The Trauma triad of death is a medical term describing the combination of hypothermia, acidosis and coagulopathy. This combination is commonly seen in patients who have sustained severe traumatic injuries and results in a significant rise in the mortality rate (see Lewis (2000)).

The three conditions share a complex relationship; each factor can compound the others, resulting in high mortality if the cycle continues uninterrupted.

Severe hemorrhage in trauma diminishes oxygen delivery, causing the patient’s body temperature to drop (hypothermia). This in turn can halt the coagulation cascade, preventing blood from clotting (coagulopathy).

In the absence of blood-bound oxygen and nutrients (hypoperfusion), the body’s cells burn glucose for energy (lactic acidosis), which in turn increases the blood’s acidity (metabolic acidosis). Such an increase in acidity can reduce the efficiency of the heart muscles (myocardial performance), further reducing the oxygen delivery and hence triggering a deadly cycle.