#Trauma triad of death skin#
#Trauma triad of death series#

8 Decreased blood volume as a result of acute hemorrhage can produce shock due to decreased preload. It is a cyclical process that causes insufficient supply and inadequate distribution of oxygen, causing serious alterations that produces the state of microcirculation insufficiency. 7 So the blood pressure is maintained by increased vascular resistance and cardiac output. 6 There is an increase in systemic vascular resistance to maintain blood pressure, causing a redistribution of the flow to vital organs (brain, kidney, heart) and an increase in sympathetic activity and cardiac contractility with decreased vagal activity.

#Trauma triad of death skin#

Abdominal organs tolerate between 45 and 90 min and skin and muscle tissue from 4 to 6 hours. Organs affected by hypoxia differ in their response to the hypoxia out of all tissues heart, lung and brain can only sustain for 4 to 6 min. The availability of O 2, 4,5 which is equal to the product of minute volume by the arterial oxygen concentration, cannot be maintained for a long time and ultimately it leads to acidosis and cell death by hypoxia. The measurement of lactic acid or base difference allows us to control the evolution of the state of hemorrhagic shock. Compensatory mechanisms are activated, including the metabolic response to trauma to compensate for blood volume. The physiological response to the presence of hypovolemic state resulting from a decrease in the effective circulating volume is triggered. 4 Inadequate blood and blood products transfusion therapy directly affects blood pressure and an inadequate perfusion pressure in the microcirculation. This resuscitation should be timely and efficient, in order to maintain an adequate balance between the delivery, transport and consumption of oxygen, and correction of hypoperfusion state.

Goal-directed resuscitation in the trauma patient includes use of intravenous fluid and blood derivatives, as well as ventilatory strategies to correct the death triad. It also helps to take into account the appropriate anesthetic decisions, their clinical management and the numerous controversies regarding the management of resuscitation goals. It is important to know the pathophysiology of trauma, as it allows us to quickly identify the patients in a state of hemorrhagic shock so that a rapid control of the source of hemorrhage and resuscitation can be achieved. If the triad of death: hypothermia, acidosis and coagulopathy are not corrected in a timely manner, the surgical control of bleeding alone will not succeed. Those surgical lesions that threaten the life are addressed, leaving the definitive repair for a latter day.

#Trauma triad of death series#

All these measures of resuscitation are time dependent and together mean series of simple procedures intended for physiological and hemodynamic stabilization of the polytrauma patient as urgently as possible. Anesthesiologist must consider these factors in a polytrauma patient during damage control surgery (DCS). 1To correct the lethal triad, the goals of resuscitation in the traumatized patient continue to be the subject of ongoing debate and there is no universal consensus at present however, the delay in initiating resuscitation goals correlates with the increase in complications. Mild hypothermia may alter immune response mechanisms such as chemotaxis, granulocyte phagocytosis, macrophage motility, and the production of anticonvulsants.Īt the time of trauma, in the golden hour and during all phases of resuscitation, there are several factors that contribute to the production of hypothermia including exposure, hypovolemia, hypoperfusion and aggressive administration of intravenous fluids. There is a decrease in microbial death, because the production of oxygen radicals is dependent on tissue oxygen tension. Vasoconstriction reduces the partial pressure of oxygen in the tissues. Hypothermia may increase the susceptibility of patients to infection in the surgical wound by peripheral vasoconstriction and impaired immunity. Hypothermia in the patient with trauma must be differentiated from accidental or exposure hypothermia and that induced for therapeutic purposes.