An unstable polytrauma patient in the operating theatre is found to have core temperature 34 degrees Celsius, pH 7.18, and diffuse non-surgical bleeding from raw surfaces. Which triad best describes the self perpetuating cycle responsible for this coagulopathy?
- A Hypothermia, acidosis, and coagulopathy ✓
- B Hypocalcaemia, hyperkalaemia, and acidosis
- C Anaemia, thrombocytopenia, and hypothermia
- D Hypoxia, acidosis, and hypercarbia
Correct answer: A. Hypothermia, acidosis, and coagulopathy
Explanation
The lethal triad of trauma consists of hypothermia, metabolic acidosis, and coagulopathy, each worsening the others. Hypothermia below 35 degrees impairs platelet function and clotting enzyme activity, acidosis degrades fibrinogen and impairs the coagulation cascade, and the resulting bleeding worsens shock and acidosis. Recognition of this triad is the rationale for damage control surgery, active rewarming, correction of acidosis, and empiric balanced transfusion rather than waiting for laboratory confirmation of coagulopathy.
Reference: ATLS Student Course Manual, 10th ed.
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