Dilutional coagulopathy is caused by both prehospital and in-hospital trauma resuscitation with standard resuscitation fluids (e.g. crystalloids and colloids). [12] Dilutional coagulopathy is due to the physical dilution of the clotting factors in the blood stream with non-oxygen carrying fluids (e.g. crystalloids) that therefore decreases the concentration of clotting factors available for use by the body at the site of tissue injury.
Poor resuscitation strategies can also influence the onset, duration, and severity of the lethal triad. Traditional trauma assessment and resuscitation courses and guidelines previously advocated for large amounts of crystalloids to be infused to bring the blood pressure back to normal levels, thereby improving hemodynamics and perfusion to the brain. However, recent studies and research has refuted this as an acceptable treatment modality for patients suffering from hemorrhagic shock.
Crystalloid fluids, such as Ringer's Lactate and 0.9% normal saline, are resuscitation fluids typically carried by prehospital providers. When used for the sole purpose of improving the blood pressure, these fluids perform rather well. However, it is well demonstrated that large amounts of crystalloids are detrimental to the patient suffering from hemorrhagic shock and should be used sparingly if at all. [25] This is because crystalloids have no oxygen-carrying capacity and do little to improve oxygen delivery in patients suffering from all types of shock states, including hemorrhagic shock. They can be harmful to a patient because they can contribute to the physiological derangements caused by the lethal triad. [25]
