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Clinical Life Sciences 2 > Trauma Triad > Flashcards

Trauma Triad Flashcards

1
Q

What are the 3 ‘components’ of the trauma triad?

A

Hypothermia
Coagulopathy
Acidosis

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2
Q

Under what temperature is a patient HYPOthermic?

A

<35C

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3
Q

How does the body generate heat?

A

Metabolism in muscle and livers

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4
Q

What are 5 means of heat loss?

A
  1. Conduction
  2. Convection
  3. Radiation (60%)
  4. Evaporation
  5. Respiration
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5
Q

What are some risk factors in patients for developing hypothermia?

A

ET tube, Trauma score, Low BP, Fluid bolus, head trauma and clothing (lack of)

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6
Q

Where are thermoreceptors?

A

Skin and Hypothalamus

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7
Q

Where is the thermal control centre?

A

Preoptic area of the hypothalamus

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8
Q

What are mechanisms to help increase body temperature?

A
  1. Vasoconstriction
  2. Adrenaline and NA release
  3. Shivering
  4. Increase in metabolic rate
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9
Q

How can haemorrhagic shock cause hypothermia?

A

A loss of blood volume

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10
Q

How can a brain injury lead to hypothermia?

A

Distruption of the central control centre

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11
Q

How can intoxication lead to hypothermia?

A

Peripheral vasodilation leads to heat loss

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12
Q

How can exposure lead to hypothermia?

A

Increased radiant heat loss

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13
Q

How can burns lead to hypothermia?

A

Skin damage leading to a loss of fluid and plasma

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14
Q

How can the administration of IV fluids lead to hypothermia?

A

Temperature of fluids leads to cooling of circulating fluid

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15
Q

What ECG changes are seen in hypothermia?

A 
J wave (due to increased Calcium)
ST elevation (early repolarisation)
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16
Q

How is it best to warm patients prehospitally?

A

Dry the patient
Cover the patient
Cover wounds and burns
Increase the surrounding temperature

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17
Q

How can hypothermia cause coagulopathy?

A

A reduction in enzyme activity and the decrease in activity of clotting factors and platelets

18
Q

Why must you be cautious when administering drugs to hypothermic patients?

A

A reduction in metabolism and elimination leads to slower responses. This means it is possible to overdose these patients more easily

19
Q

What is ‘normal coagulation’ defined as?

A

A complex set of reactions that form blood clots preventing haemorrhage

20
Q

What is normal coagulation dependent on?

A 
Temperature (HYPOTHERMIA)
Blood pH (ACIDOSIS)
21
Q

What two things are essential for coagulation?

A

Calcium ions and Platelets?

22
Q

What are the two coagulation pathways?

A

Extrinsic

Intrinsic

23
Q

What causes the extrinsic pathway to be activated?

A

Tissue Trauma

24
Q

What causes the intrinsic pathway to be activated?

A

Blood/Vessel trauma

Collagen fibre and platelet exposure

25
Q

What is produced to activate the extrinsic pathway?

A

Tissue Factor

calcium

26
Q

What is produced to activate the intrinsic pathway?

A

Activated clotting factor 12 and Activated platelets

calcium

27
Q

Prothrombinase catalyses what reaction?

A

Prothrombin –> Thrombin

28
Q

What does thrombin catalyse?

A

Fibrinogen –> Fibrin

29
Q

What 5 things can loss of blood lead to in coagulopathy?

A
  1. Loss of clotting factors
  2. Haemodilution (fluids)
  3. Hypothermia (clotting and enzymes)
  4. Acidosis (clotting, enzymes and platelets)
  5. Hypocalcaemia (haemodilution)
30
Q

What is blood calcium essential for?

A

Normal clotting mechanisms

31
Q

What is normal blood pH?

A

7.35-7.45

32
Q

Under what blood pH is it considered ‘acidosis’?

A

<7.35

33
Q

What 3 mechanisms are used to regulate blood pH normally?

A
  1. Renal system (excreted H ions + reabsorbs HCO3)
  2. Respiration (expire CO2)
  3. Blood buffering
34
Q

What is the Bohr effect equation?

A

CO2 + H2O –> H2CO3 –> HCO3- + H+ –> excretion

35
Q

What are the two main ‘types’ of acidosis?

A
  1. Metabolic acidosis

2. Respiratory acidosis

36
Q

How does metabolic acidosis occur?

A

Tissue hypoxia causes anaerobic metabolism to occur producing lactic acid which causes acidosis.

37
Q

How does respiratory acidosis occur?

A

A reduction in respiratory rate leads to impaired CO2 expulsion. This leads to hypercapnia and thus acidosis.

38
Q

What can cause respiratory acidosis (resp damage)?

A
  • Trauma
  • Drugs and alcohol
  • Head injury
  • COPD
39
Q

What can cause metabolic acidosis?

A
  • Blood loss
  • Hypothermia
  • Decreased cardiac output
40
Q

How does the administration of NaCl worsen acidosis?

A

Cl ions reduce bicarbonate reabsorption
Cl ions affect ioinic balance
Dilution of coagulation factors
Acidosis (pH 4-5)

41
Q

What is the equation for plasma pH?

A

[HCO3]/PCO2

Clinical Life Sciences 2 (7 decks)

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