What component of the trauma triad of death is most likely to have started at the time of severe injury in a patient with hypovolemic shock?

The trauma triad of death, which consists of coagulopathy, hypothermia, and acidosis, represents a potentially lethal combination that can occur in severe trauma cases. Among these, coagulopathy is particularly significant because it can begin immediately following severe injury, especially in the context of hypovolemic shock.

When a patient experiences a severe traumatic injury, significant blood loss can lead to hypoperfusion and subsequent hypovolemic shock. As the body loses blood volume, the coagulation cascade can be disrupted. This disruption occurs because of a combination of factors, including dilution of clotting factors due to continued loss of blood and volume resuscitation with crystalloids. Furthermore, the release of tissue factor from injured tissues can activate the coagulation system, leading to an increased consumption of clotting factors and platelets, which further exacerbates coagulopathy.

Coagulopathy is often observed early in trauma cases, particularly with the development of shock, making it an immediate concern that clinicians must address to prevent mortality. In contrast, hypothermia and acidosis may develop later as the body's response to trauma and shock evolves, particularly with prolonged time to definitive care or resuscitation.

Thus, coagulopathy is the component of the