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Hypothermia, coagulopathy, and acidosis
V A Eddy1, J A Morris, D C Cullinane
1Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
The Surgical Clinics of North America
|July 18, 2000
Summary
Managing critically ill trauma patients with hypothermia, coagulopathy, and acidosis requires aggressive intervention. Early identification and treatment of these conditions, including blood component transfusions, improve survival for severely injured patients.
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Physiology
Background:
- Patients requiring damage control surgery present complex metabolic derangements.
- The 'deadly triad' of hypothermia, coagulopathy, and acidosis complicates management.
- Effective trauma center capabilities are essential for these critical patients.
Purpose of the Study:
- To outline the management strategies for trauma patients with severe metabolic abnormalities.
- To highlight the importance of rapid diagnosis and intervention for hypothermia and coagulopathy.
- To emphasize the role of damage control resuscitation in improving outcomes.
Main Methods:
- Utilizing volumetric, oxymetric pulmonary artery catheters for monitoring hypothermia and cardiovascular status.
- Employing external, forced air rewarming and body cavity lavage for hypothermia.
- Initiating empirical platelet and plasma or cryoprecipitate transfusions for coagulopathy.
Main Results:
- Rapid identification and monitoring of hypothermia and cardiovascular abnormalities are achievable.
- Aggressive rewarming techniques are effective in managing hypothermia.
- Empirical blood component transfusion addresses the rapid time course of coagulopathy.
Conclusions:
- Damage control resuscitation requires advanced trauma center capabilities.
- Prompt management of hypothermia and coagulopathy is critical for survival.
- Surgical innovation in managing severely injured patients improves survival and quality of life.