And now from the blasts at the Boston Marathon.
This is as a result of better pre-hospital, and operating room bleeding control , and from lessons learned on the battle field in Iraq and Afghanistan.
Much of what we know about trauma surgery comes from the management of the severest trauma… that which occurs on the battlefield.
This link will bring you to the most current U.S. Army Institute of Surgical Research GUIDLINES for managing the trauma patient:
The information here is astounding. As civilians, we may be unable to duplicate the military’s trauma system, but there is nothing that should get in the way of us trying.
The “Lethal Triad” or the “Triad of Death” comprises:
The two guidelines, which most completely address these issues are:
The management of acidosis is not addressed per se. It appears that clinicians treat acidosis indirectly by control of bleeding and hypoperperfusion, expecting those measures to correct the acidosis. The article on Damage Control Resuscitation mentions the use of THAM to treat acidosis. Since all three conditions in the Lethal Triad contribute to bleeding, should not all be treated? Enzymes function best at physiological pH. So why should the non-treatment of acidosis be allowed to inhibit the enzymes that promote coagulation until coagulation and hypoperfusion are controlled by massive infusion of blood products? Would optimizing the milieu (pH) that enzymes work in permit the enzymes to work more efficiently and decrease the blood products required ?