Major trauma

doi:10.1017/CBO9780511641947.013

This chapter is part of a book that is no longer available to purchase from Cambridge Core

9 - Major trauma

from Section 1 - Clinical anaesthesia

J. P. Nolan

Edited by

Tim Smith ,

Colin Pinnock and

Ted Lin

Edited in association with

Robert Jones

Show author details

Tim Smith: Affiliation:
Alexandra Hospital, Redditch
Colin Pinnock: Affiliation:
Alexandra Hospital, Redditch
Ted Lin: Affiliation:
University of Leicester, NHS Trust
Robert Jones: Affiliation:
Withybush Hospital, Haverfordwest

Book contents

Get access

Summary

In the United Kingdom, trauma kills 14,500 people annually and is the commonest cause of death in those under 40 years. The advanced trauma life support (ATLS) course (American College of Surgeons Committee on Trauma 2004) provides a basic framework onto which hospital specialists can build their individual skills. The ATLS course focuses on the initial management of patients with major injuries during the so-called ‘golden hour’. The golden hour reflects the importance of timely treatment. A severely injured patient who is hypoxic, in haemorrhagic shock, or who has an expanding intracranial haematoma, for example, will need rapid, effective resuscitation. The aim is to restore cellular oxygenation before the onset of irreversible shock.

Pathophysiology of trauma and hypovolaemia

Several mechanisms are involved in the development of cellular injury after severe trauma. The commonest is haemorrhage, causing circulatory failure with poor tissue perfusion and generalised hypoxia (hypovolaemic shock). Myocardial trauma may cause cardiogenic shock, while spinal cord trauma may cause neurogenic shock. Severe trauma is a potent cause of the systemic inflammatory response syndrome (SIRS) and this may progress to the multiple organ dysfunction syndrome (MODS) and multiple organ failure.

Physiological responses to haemorrhage

Trauma compromises tissue oxygenation because haemorrhage reduces oxygen delivery and tissue injury and inflammation increase oxygen consumption.

Compensatory responses to haemorrhage are categorised into immediate, early and late. The loss of blood volume is detected by low-pressure stretch receptors in the atria and arterial baroreceptors in the aorta and carotid artery.

Information

Type: Chapter
Information: Fundamentals of Anaesthesia , pp. 156 - 172

DOI: https://doi.org/10.1017/CBO9780511641947.013 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

,American College of Surgeons Committee on Trauma. Advanced Trauma Life Support for Doctors. Student Course Manual. Chicago: American College of Surgeons, 2004.

Boffard, KD, Riou, B, Warren, B, et al. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials. J Trauma 2005; 59: 8–15; discussion 15–18.Google Scholar

Bone, RC, Balk, RA, Cerra, FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 101: 1644–55.Google Scholar

Brohi, K, Healy, M, Fotheringham, T, et al. Helical computed tomographic scanning for the evaluation of the cervical spine in the unconscious, intubated trauma patient. J Trauma 2005; 58: 897–901.Google Scholar

Bullock, R, Chesnut, RM, Clifton, G, et al. Guidelines for the management of severe head injury. Brain Trauma Foundation. Eur J Emerg Med 1996; 3: 109–27.Google Scholar

Cobb, JP, O'Keefe, GE. Injury research in the genomic era. Lancet 2004; 363: 2076–83.Google Scholar

Cook, TM, Hommers, C. New airways for resuscitation? Resuscitation 2006; 69: 371–87.Google Scholar

Cook, TM, Lee, G, Nolan, JP. The ProSealTM laryngeal mask airway: a review of the literature. Can J Anaesth 2005; 52: 739–60.Google Scholar

Finfer, S, Bellomo, R, Boyce, N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004; 350: 2247–56.Google Scholar

Giannoudis, PV. Current concepts of the inflammatory response after major trauma: an update. Injury 2003; 34: 397–404.Google Scholar

Goris, RJ. MODS/SIRS: result of an overwhelming inflammatory response? World J Surg 1996; 20: 418–21.Google Scholar

Hauser, CJ, Visvikis, G, Hinrichs, C, et al. Prospective validation of computed tomographic screening of the thoracolumbar spine in trauma. J Trauma 2003; 55: 228–34; discussion 234–5.Google Scholar

Hoffman, JR, Mower, WR, Wolfson, AB, Todd, KH, Zucker, MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med 2000; 343: 94–9.Google Scholar

Lee, CC, Marill, KA, Carter, WA, Crupi, RS. A current concept of trauma-induced multiorgan failure. Ann Emerg Med 2001; 38: 170–6.Google Scholar

Maas, AI, Dearden, M, Teasdale, GM, et al. EBIC-guidelines for management of severe head injury in adults. European Brain Injury Consortium. Acta Neurochir (Wien) 1997; 139: 286–94.Google Scholar

McLeod, AD, Calder, I. Spinal cord injury and direct laryngoscopy: the legend lives on. Br J Anaesth 2000; 84: 705–9.Google Scholar

Moore, FA, McKinley, BA, Moore, EE. The next generation in shock resuscitation. Lancet 2004; 363: 1988–96.Google Scholar

Morris, CG, McCoy, E. Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening. Anaesthesia 2004; 59: 464–82.Google Scholar

Morris, CG, Mullan, B. Clearing the cervical spine after polytrauma: implementing unified management for unconscious victims in the intensive care unit. Anaesthesia 2004; 59: 755–61.Google Scholar

,National Institute for Clinical Excellence. Head Injury: Triage, Assessment, Investigation and Early Management of Head Injury in Infants, Children and Adults. London: NICE, 2003.

Navarrete-Navarro, P, Rodriguez, A, Reynolds, N, et al. Acute respiratory distress syndrome among trauma patients: trends in ICU mortality, risk factors, complications and resource utilization. Intensive Care Med 2001; 27: 1133–40.Google Scholar

Nolan, JP, Parr, MJA. Aspects of resuscitation in trauma. Br J Anaesth 1997; 79: 226–40.Google Scholar

Nolan, JP, Wilson, ME. Orotracheal intubation in patients with potential cervical spine injuries: an indication for the gum elastic bougie. Anaesthesia 1993; 48: 630–3.Google Scholar

Oakley, PA. Setting and living up to national standards for the care of the injured. British Trauma Society. Injury 1994; 25: 595–604.Google Scholar

Parr, MJ, Alabdi, T. Damage control surgery and intensive care. Injury 2004; 35: 713–22.Google Scholar

Roberts, I, Evans, P, Bunn, F, Kwan, I, Crowhurst, E. Is the normalisation of blood pressure in bleeding trauma patients harmful? Lancet 2001; 357: 385–7.Google Scholar

Roumen, RM, Redl, H, Schlag, G, et al. Inflammatory mediators in relation to the development of multiple organ failure in patients after severe blunt trauma. Crit Care Med 1995; 23: 474–80.Google Scholar

Saadia, R, Lipman, J. Multiple organ failure after trauma. BMJ 1996; 313: 573–4.Google Scholar

Sessler, DI. Complications and treatment of mild hypothermia. Anesthesiology 2001; 95: 531–43.Google Scholar

Shapiro, MB, Jenkins, DH, Schwab, CW, Rotondo, MF. Damage control: collective review. J Trauma 2000; 49: 969–78.Google Scholar

Thomas, I, Dixon, J. Bradycardia in acute haemorrhage. BMJ 2004; 328: 451–3.Google Scholar

Accessibility standard: Unknown

Why this information is here

This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.

Accessibility Information

Accessibility compliance for the PDF of this chapter is currently unknown and may be updated in the future.