Review Article: PDF OnlyA review of transfusion- and trauma-induced hypocalcemia. Is it time to change the lethal triad to the lethal diamond?Ditzel, Ricky Michael Jr SO-ATP, CCP-C, FP-C; Anderson, Justin Lee Bachelor of Health Science, SO-ATP, EMT-P; Eisenhart, William Joseph Master of Art, SO-ATP, EMT-P, TP-C, FP-C, MPAS-student; Rankin, Cody Jack SO-ATP, CCP-C, FP-C; DeFeo, Devin Robert Bachelor of Art, SO-ATP; Oak, Sangki Bachelor of Science/MS-4; Siegler, Jeffrey MD, EMT-P, EMT-T, FAEMSAuthor Information George Washington University/United States Army Special Operations Command United States Army Special Operations Command Yale University United States Army Special Operations Command Uniformed Services University of Health Sciences University of Pittsburgh School of Medicine Washington University School of Medicine Correspondence will be sent to: Justin Anderson, 1312 Sunswept Circle, Raleigh, NC 27603. 1-775-530-7970. firstname.lastname@example.org Ricky Michael Ditzel, Jr. and Justin Lee Anderson co-first authorship Conflicts of Interest and Sources of Funding: The authors declare no conflicts of interest. No funding received in the writing of this piece. The preliminary ideas for this paper were presented by Ricky Ditzel at the Annual Meeting of the Committee for Tactical Emergency Casualty Care, May 13-17, 2018 in Charlotte, NC and at the 31st Annual Meeting of the Special Operations Medical Association’s Special Operations Medical Scientific Assembly, May 6-10, 2019 in Charlotte, NC. The discussions generated by this presentation subsequently drove changes to the Joint Trauma System's Damage Control Resuscitation Clinical Practice Guideline. Journal of Trauma and Acute Care Surgery: December 23, 2019 - Volume Publish Ahead of Print - Issue - doi: 10.1097/TA.0000000000002570 Buy PAP Metrics Abstract The understanding of trauma management and damage control resuscitation is constantly changing as new research becomes available. While poor outcomes in hemorrhagic shock have traditionally been attributed to the “lethal triad” of hypothermia, coagulopathy, and acidosis, research has suggested that hypocalcemia may also play an integrated part in this interaction. Studies have shown a prevalence of hypocalcemia in trauma patients, as well as greater mortality associated with severe hypocalcemia in trauma. Given that whole blood is becoming the fluid of choice in resuscitation and that the citrate used to preserve blood products can worsen existing hypocalcemia, prompt management of hypocalcemia becomes even more of a concern. For these reasons, the authors of this paper suggest hypocalcemia in trauma patients may be of greater importance than originally believed and propose creating the “lethal diamond” of trauma comprised of hypocalcemia, acidosis, coagulopathy, and hypothermia. It is hoped that this increased focus on hypocalcemia in trauma can lead to research regarding early administration of calcium with the hopes of improving trauma patient outcomes. Level of Evidence: Therapeutic/care management Level IV. Study Type: Review article. © 2020 Lippincott Williams & Wilkins, Inc.