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Podcast Episode 25: Lethal Triad Trauma Class Video

6 Comments »

  1. Sir,
    Thank you for the legal triad refresher! As an Army Physician I really appreciate the brevity of this type of educational material that packs a knowledge punch.

    On the subject of acidemia, in the absence of whole blood transfusion would you recommend using either Lactated Ringer or Plasmalyte OVER abnormal sodium chloric acid? I mean, “normal” saline?

    Overwhelming majority of medical professionals, including combat medics AND critical care intensivists, have no clue that so-called “normal” saline has a pH of 5.5. Per human physiology, not only will this crystalloid worsen existing acidemia, it will also cause hyperkalemia as a result of Hydrogen-Potassium cellular transport. The cells themselves will participate in regulating blood pH by taking in one Hydrogen and pumping out one Potassium as this also balances out the charge difference.

    By the way, Lactated Ringer has a pH 6.8 and Plasmalyte 7.4.

    Appreciate the educational material! Please keep up the great work!

    Doc Who (My last name has the same pronunciation)

    • Thank you for the feedback. Yes, I would say most medical professionals roll their eyes and go to sleep just mentioning acid/base balance, however they are missing a important piece of the equation. If I had to choose a crystalloid in this situation it would be plasmalyte, then LR, and very last would be NS 0.9%. None of them carry oxygen and all are going to dilute the buffering capacity, but Plasmalyte is the least bad choice in my opinion. In an up coming podcast I talk to Dr. Cap about fluids and Resus and talk about this very concept. Hope you enjoy it.

  2. This is one of my favorite podcasts on the Lethal Triad and I have shared it with dozens in the past. The triad is one of the most important concepts of trauma (and shock in general) management and our understanding of it and two of its components’ impact on binding of O2 to hemaglobin, gives us more critical thinking tools when things are not going right despite our best efforts. I love the site and the information you guys are constantly putting out.

  3. Sir, as a combat medic, the lethal triad was not talked about very much in my training. I have recently been tasked to research acidosis in the lethal triad. With this research I have found that BVMs are actually encouraged to increase the oxygen within your patients system. Due to the aerobic transfer to anaerobic cellular respiration the cells are creating lactic acid as a byproduct because to the lack of oxygen supply. This creates lactic acidosis in casualties which then spirals into the lethal triad. In your video you explain that a BVM could hinder your casualty’s recovery by slowing down the heart rate which inherently reduces the amount of blood that is being perfused. Is it more important to optimize tissue oxygen delivery or to keep the patients heart rate up with the increase in respirations?
    You video was very insightful!
    Thank you, Rowland

  4. Sir, as a combat medic, the lethal triad was not talked about very much in my training. I have recently been tasked to research acidosis in the lethal triad. With this research I have found that BVMs are actually encouraged to increase the oxygen within your patients system. Due to the aerobic transfer to anaerobic cellular respiration the cells are creating lactic acid as a byproduct because of the lack of oxygen supply. This creates lactic acidosis in casualties which then spirals into the lethal triad. In your video you explain that a BVM could hinder your casualty’s recovery by slowing down the heart rate which inherently reduces the amount of blood that is being perfused. Is it more important to optimize tissue oxygen delivery or to keep the patients heart rate up with the increase in respirations?
    Your video was very insightful!
    Thank you, Rowland

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