Overview of Trauma Physiology
Trauma physiology examines the body's responses to severe physical injury. Understanding these responses is crucial for effective management and treatment of trauma patients, aiming to stabilize vital functions, prevent complications, and promote recovery.
Physiological Responses to Trauma
- Haemodynamic Changes:
- Hypovolemic Shock: Caused by significant blood loss leading to decreased blood volume and inadequate tissue perfusion.
- Vasoconstriction: Blood vessels constrict to maintain blood pressure and prioritize blood flow to vital organs.
- Increased Heart Rate: The heart rate increases to compensate for decreased blood volume and maintain cardiac output.
- Inflammatory Response:
- Cytokine Release: Trauma triggers the release of inflammatory cytokines, leading to systemic inflammation.
- Leukocyte Activation: White blood cells are activated to combat infection and aid in tissue repair.
- Coagulation Cascade: Activation of the coagulation system to prevent further bleeding and promote clot formation.
- Metabolic Response:
- Hypermetabolism: Increased metabolic rate to support healing and recovery processes.
- Catabolism: Breakdown of muscle and fat stores to provide energy substrates.
- Insulin Resistance: Decreased sensitivity to insulin, leading to elevated blood glucose levels.
Phases of Trauma Response
- Immediate Phase (Minutes to Hours):
- Initial response involving haemostasis and shock management.
- Primary focus on airway, breathing, circulation, and bleeding control (ABCs).
- Acute Phase (Hours to Days):
- Ongoing resuscitation and stabilization of the patient.
- Management of systemic inflammatory response and prevention of complications.
- Chronic Phase (Days to Weeks):
- Long-term recovery and rehabilitation.
- Focus on tissue healing, nutrition, and physical therapy.
Key Organ Systems Affected by Trauma
- Cardiovascular System:
- Maintaining perfusion and oxygen delivery to tissues is critical.
- Management of haemorrhage and prevention of shock are priorities.
- Respiratory System:
- Ensuring adequate ventilation and oxygenation.
- Addressing issues such as pneumothorax, haemothorax, and pulmonary contusions.
- Renal System:
- Monitoring and maintaining renal perfusion and function.
- Preventing acute kidney injury (AKI) due to hypoperfusion or rhabdomyolysis.
- Nervous System:
- Assessment and management of traumatic brain injury (TBI).
- Monitoring for signs of increased intracranial pressure (ICP) and spinal cord injury.
Trauma Assessment and Management
- Primary Survey (ABCs):
- Airway: Ensure airway patency and protect the cervical spine.
- Breathing: Assess and support breathing and ventilation.
- Circulation: Control haemorrhage and support circulation.
- Disability: Assess neurological status using the Glasgow Coma Scale (GCS).
- Exposure: Expose the patient to identify all injuries while preventing hypothermia.
- Secondary Survey:
- Detailed head-to-toe examination to identify all injuries.
- Includes history taking and reassessment of vital signs.
- Resuscitation:
- Fluid resuscitation to restore intravascular volume.
- Blood transfusion for significant haemorrhage.
- Use of vasopressors and inotropes if necessary to support blood pressure and cardiac output.
Complications of Trauma
- Acute Respiratory Distress Syndrome (ARDS):
- Severe lung injury leading to impaired gas exchange and respiratory failure.
- Management includes mechanical ventilation and supportive care.
- Sepsis:
- Systemic infection that can lead to multiple organ dysfunction syndrome (MODS).
- Requires early recognition and aggressive antimicrobial therapy and supportive care.
- Coagulopathy:
- Abnormal blood clotting, often resulting from massive transfusion or severe trauma.
- Management includes blood product administration and correction of clotting factor deficiencies.
- Compartment Syndrome:
- Increased pressure within a closed muscle compartment leading to ischaemia and tissue damage.
- Requires prompt surgical intervention (fasciotomy) to relieve pressure.
Rehabilitation and Recovery
- Physical Therapy:
- Essential for restoring function, strength, and mobility.
- Psychological Support:
- Addressing mental health issues such as post-traumatic stress disorder (PTSD) and depression.
- Occupational Therapy:
- Assisting patients in regaining independence in daily activities.
- Follow-Up Care:
- Regular medical evaluations to monitor progress and manage long-term complications.
Summary
Trauma physiology involves understanding the body's responses to severe injury, including haemodynamic, inflammatory, and metabolic changes. Effective management includes rapid assessment and stabilization, addressing specific organ system injuries, and preventing complications. Long-term recovery and rehabilitation are essential for restoring function and improving quality of life for trauma patients.