The Pathophysiology Of Trauma

Despite advances in the early treatment of trauma, it remains one of the major causes of death and disability in the UK. The adaptation of the ATLSĀ® framework has had a huge impact on the management of trauma in the UK, with the aim of identifying and managing immediately life-threatening conditions and the prevention of a cascade of metabolic events that can lead to the deterioration in a patient's condition. The understanding of the pathophysiology of severe

Age (years)

Figure 7.1. Improvement in survival of burns patients over the last 30 years.

Age (years)

Figure 7.1. Improvement in survival of burns patients over the last 30 years.

trauma is vitally important in the management of the injured patient, as early recognition and correction of abnormalities are pivotal to preventing complications such as sepsis and secondary brain injury that become apparent after the initial management is successful and the patient is moved to the intensive care unit. Sepsis remains a major cause of mortality and is an area into which a lot of research is being focused and the understanding of the pathophysiology of trauma is helping in the search for future treatment modalities.

The pathophysiology of severe trauma is a multisystem response to local and systemic stimuli with interactions between the sympatho-adrenal system, hormones, cytokines and vascular endothelium. The majority of the metabolic changes occur in order to conserve energy and redirect energy sources to vital organs. The emphasis in initial management of the trauma patient remains on correcting hypo-volaemia, acid-base disturbance and hypoxia. In the longer term, the maintenance of enteral nutrition, wound care and the prevention of infection take over.

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