The Trauma Diamond of Death is a critical framework in trauma medicine, emphasising four interconnected factors that significantly impact patient outcomes:
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Coagulopathy: Abnormal blood clotting can lead to uncontrolled bleeding in trauma patients. Addressing coagulopathy promptly is crucial.
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Acidosis: Acidosis occurs when the body’s pH becomes too acidic. In trauma, acidosis can result from tissue hypoxia, shock, or other metabolic disturbances. It interferes with normal blood clotting mechanisms and worsens coagulopathy.
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Hypothermia: A drop in body temperature can exacerbate coagulopathy and impair enzymatic reactions. Hypothermia affects the body’s ability to clot blood effectively.
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Hypocalcaemia: Low calcium levels play a significant role in trauma outcomes. Hypocalcaemia prolongs coagulation and affects cardiac function. While calcium infusions are commonly used in hospital settings, prehospital paramedics may not have immediate access to them.
Applicability to Prehospital Paramedicine
Considering the context of prehospital paramedicine:
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Resource Constraints: In comparison to the hospital environment, resources are limited in prehospital settings. While paramedics focus on advanced life support measures, including airway management, bleeding control (both physical and pharmacological), sedation and rapid transport to a trauma center. Calcium infusions may not always be accesible and is often not in the scope of practice of a paramedic. Along with paramedic equipment, our Bleed Control Kits contain items to help prevent the Trauma Triad of Death.
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Collaboration: Paramedics work closely with prehospital emergency physicians. While addressing hypothermia, acidosis, and coagulopathy remains critical, considering what interventions may be provided by prehospital emergency physicians may be useful when requesting critical care support.
References found here