From the Guidelines
The triangle of death, also known as the lethal triad, refers to a state of profound acidosis, hypothermia, and coagulopathy that occurs in severely injured patients with continuing bleeding or deep haemorrhagic shock. This condition is dangerous because it can lead to a high risk of morbidity and mortality if not promptly addressed. The triangle of death is characterized by the following components:
- Acidosis: a state of increased acidity in the blood, which can lead to organ dysfunction and failure
- Hypothermia: a state of decreased body temperature, which can lead to coagulopathy and increased bleeding
- Coagulopathy: a state of impaired blood clotting, which can lead to uncontrolled bleeding and hemorrhage
The following table explains the triangle of death and its associated structures and complications:
| Component | Description | Complications |
|---|---|---|
| Acidosis | Increased acidity in the blood | Organ dysfunction and failure |
| Hypothermia | Decreased body temperature | Coagulopathy and increased bleeding |
| Coagulopathy | Impaired blood clotting | Uncontrolled bleeding and hemorrhage |
According to the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1, the triangle of death is a critical condition that requires prompt recognition and treatment to prevent morbidity and mortality. The guideline recommends early control of bleeding, proper resuscitation, and blood transfusion to achieve optimal outcomes. Additionally, the concept of damage control, which consists of abbreviated resuscitative laparotomy, intensive care treatment, and definitive surgical repair, has been shown to be beneficial in reducing morbidity and mortality in severely injured patients 1.
In summary, the triangle of death is a critical condition that requires prompt recognition and treatment to prevent morbidity and mortality, and the concept of damage control has been shown to be beneficial in reducing morbidity and mortality in severely injured patients. Key points to consider in the management of the triangle of death include:
- Early control of bleeding and proper resuscitation
- Blood transfusion and coagulopathy management
- Damage control techniques, including abbreviated resuscitative laparotomy and intensive care treatment
- Definitive surgical repair when target parameters have been achieved.
From the Research
Definition of the Triangle of Death
The triangle of death refers to a region in the groin area where the femoral vein, artery, and nerve are located, and is associated with a high risk of severe bleeding and complications in cases of trauma or injury [ 2 ].
Associated Structures
The triangle of death is bounded by the following structures:
- The inguinal ligament
- The lacunar ligament
- The femoral vein and artery
Complications
Complications associated with the triangle of death include:
- Severe bleeding and hemorrhage
- Injury to the femoral vein, artery, or nerve
- Infection and sepsis
- Amputation and fractures [ 2 ]
Table Explaining the Triangle of Death
| Structure | Location | Complications |
|---|---|---|
| Femoral Vein | Medial aspect of the femoral sheath | Severe bleeding, hemorrhage |
| Femoral Artery | Lateral aspect of the femoral sheath | Severe bleeding, hemorrhage |
| Femoral Nerve | Posterior aspect of the femoral sheath | Nerve damage, numbness |
| Inguinal Ligament | Bounding the triangle of death | Injury, bleeding |
| Lacunar Ligament | Bounding the triangle of death | Injury, bleeding |
Management of Complications
Management of complications associated with the triangle of death requires a multidisciplinary approach, including: