The Lethal Triad of Trauma

Hey guys,

Thanks for many of you turning up to the first C & C this morning.
I was pleased to see most of you appeared comfortable making contribution to the discussions, as that’s one of the most important objectives for this catch up.
Yes, it may be slightly daunting for some to express your view or ask questions in front of others, but I really love to create a supportive environment especially for our younger generation of great EMTs and ILSs we have on our shift, and ICPs will also certainly benefit during the process of mutual learning.

Here is the summary and some of the links from the discussions we had this morning.
I’ve kept the links mainly to the non-academic journals as not everyone has an access to the journal libraries.

Lethal triad of trauma and damage control resuscitation

Greater Sydney Area HEMS article
Thoughts on the Resuscitation of the Critically Ill Trauma Patient (PDF)
Damage Control Surgery and Damage Control Resuscitation (LIFL)

Our role can enhance the chain of survival for the critical injured Pts by understanding the principal and underlying pahothophysiology.

Lethal triad

Hypothermia – often forgotten but simple techniques i.e. wrap them up well, pre-heat the ambulance etc, may contribute big time for the outcome.
Hibler’s method of rewarming –

Coagulopathy – Administering 0.9% NaCl not only haemodilutes, but also may contribute to worsening of acidosis, hypothermia, and increased BP/hydrostatic pressure mechanically disturb existing clots.
Fluid challenge needs to be kept just to perfuse vital organs to sustain life. Our guidelines gives palpable pulse, unrecordable BP as a tools you can use to assess the minimum perfusion pressure required. International guidelines gives MAP>65mmHg as another clue to sustain life.
MAP = Diastolic BP + Pulse pressure/3 (Pulse pressure = Systolic BP – Diastolic BP)
ICPs may consider inotropic augmentation by adrenaline infusion instead of large dose of saline infusion.

Acidosis – there is no quick fix for this pre-hospitally, but we can try slowing down or stop the process by maximising oxygenation/ventilation, and reducing cellular metabolism by minimising stressor i.e. pain. It is also synergistic with other triad, so improving other elements of triad will contribute to the improvement of acidosis i.e. keeping Pt warm.

Shane also talked about Impact Brain Apnoea

Impact Brain Apnoea with Gareth Davies from London HEMS …
Brain Impact Apnoea | LITFL: Life in the Fast Lane Medical …


The next C & C will be on the 8/Aug/16 and please expect the calendar invitation.
Karen may be able to present what she was going to present today.
Rowan will present when to stop resuscitation
Shane will present traumatic cardiac arrest

We’ve decided to have multiple presenters allocated for each C & C so we will have someone presenting as things pop up in our busy lives.
We’ve also discussed the location and at this stage we are in favour of locations where we can focus on clinical discussions / practice and also have access to the presentation media i.e. TV, whiteboard etc. Physical location wise, Hornby and Wrights Rd (Board Room) is preferred by many, but will try going to Rangiora to accommodate people living in the area as well as utilising great facilities they have.
We will try mixing up some practical and social aspect so it’s worth the people’s time as well as it is sustainable and fun.
We also have clinical department’s support and will be able to use their facilities without CSOs intervening what we are trying to do – creating a learning environment where we can go hard at discussing and practicing without fear of making mistakes.

Thanks again for your input and hope to see you on the next C & C.



2 Comments Add yours

  1. bobthebuilder64 says:

    Good on you for setting this up Tatsu..
    Well done!


    1. Tatsu Kuwasaki says:

      Thanks Mark. Hope it will contribute to the mutual benefit for everyone involved.


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