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KMID : 1033220150050020035
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Journal of Acute Care Surgery
2015 Volume.5 No. 2 p.35 ~ p.41
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Traumatic Coagulopathy
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Kim Joong-Suck
Sul Young-Hoon
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Abstract
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Trauma patients often suffer from a “lethal triad” comprised of three entwined interacting components: hypothermia, acidosis, and coagulopathy. When the patients’ blood vessels are injured, hemostatic mechanisms are activated to heal the injured vessels and reduce blood loss. Yet when the injury is substantial, hemostasis becomes insufficient, and coagulopathy develops. The patients’ coagulation factors are exhausted, and bleeding is uncontrollable, a condition similar to disseminated intravascular coagulopathy (DIC). However, traumatic coagulopathy may differ from DIC in term of mechanisms. Unlike DIC, traumatic coagulopathy results from increased protein C activity inhibiting thrombin. Moreover, overt blood loss results in shock, mandating urgent resuscitation. However imprudent resuscitation with massive fluid and transfusion may induce hypothermia and acidosis, aggravating the coagulopathy. Recent studies recommend thromboelastogram to diagnose the complex status of coagulopathy and indicate the best treatment. Physicians treating trauma patients should address these intertwined, complex complications thoroughly and thoughtfully.
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KEYWORD
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Trauma, Coagulopathy, Thromboelstogram
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