Base deficit as an early marker of coagulopathy in trauma

Shalen Cheddie, David J J Muckart, Timothy C Hardcastle
2013 South African Journal of Surgery  
Corresponding author: D J J Muckart (davidmuc@ialch.co.za) The acute coagulopathy of trauma is a complex pathophysiological state that may be initiated by a number of factors. As an integral part of the 'deadly triad' , it may be perpetuated by concomitant acidosis and hypothermia; [1] excessive pre-hospital fluid resuscitation may lead to haemodilution of clotting factors and worsening of the coagulopathy; and exposure of tissue factor when endothelium or brain matter is denuded results in
more » ... uded results in release of thromboplastins. [2] Hypoperfusion following major injury is associated with an increased expression of thrombomodulin, which binds thrombin, resulting in increased activation of protein C that subsequently inhibits plasminogen activator inhibitor, leading to increased fibrinolysis. [3] The coagulopathy of trauma is associated with an increased mortality rate, [4] and the key to improving survival lies in identifying and correcting early potentially reversible risk factors. Although traditionally hypoperfusion has been diagnosed and classified on the basis of clinical vital signs, occult hypoperfusion
doi:10.7196/sajs.1665 pmid:23941752 fatcat:hpr7rxhch5cbrfwltqgrzs75hu