Skip to main content
SpringerLink
Log in

Physiological Derangement of the Trauma Patient

  • Chapter
  • First Online:
Anesthesia for Trauma

  • 2364 Accesses

Abstract

This chapter provides a systemic review of trauma-related physiological changes with tremendous updated information. The first part of this chapter analyzed the general physiological changes according to the following categories: (1) hemorrhage-related changes: trauma-related vicious cycle of hemorrhage, resuscitation, and coagulopathy; mechanisms of acute trauma coagulopathy (excessive activation of coagulation, hyperfibrinolysis, hypothermia, acidosis, increased capillary permeability, and platelet dysfunction). (2) Stress-related changes (behavioral activation). (3) Pain-related changes (ventilation and mental status). (4) Inflammatory changes and sepsis. (5) Metabolic changes. The second part of the chapter discussed three system-specific physiological changes after trauma: head trauma, chest and cardiac trauma, and trauma to abdominal and digestive system.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Jones R. Neurogenetics: trauma and stress, from child to adult. Nat Rev Neurosci. 2013;14(2):77. doi:10.1038/nrn3425.

    PubMed  Google Scholar 

  2. An LN, Yue Y, Guo WZ, Miao YL, Mi WD, Zhang H, Lei ZL, Han SJ, Dong L. Surgical trauma induces iron accumulation and oxidative stress in a rodent model of postoperative cognitive dysfunction. Biol Trace Elem Res. 2013;151(2):277–83. doi:10.1007/s12011-012-9564-9.

    Article  CAS  PubMed  Google Scholar 

  3. Eagle AL, Knox D, Roberts MM, Mulo K, Liberzon I, Galloway MP, Perrine SA. Single prolonged stress enhances hippocampal glucocorticoid receptor and phosphorylated protein kinase B levels. Neurosci Res. 2013;75(2):130–7. pii: S0168-0102(12)00205-2. DOI:10.1016/j.neures.2012.11.001.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Eastridge B. Joint Theater Trauma Registry Data. (June 2006–November 2008) 2009.

    Google Scholar 

  5. Franklin GA, Boaz PW, Spain DA, Lukan JK, Carrillo EH, Richardson JD. Prehospital hypotension as a valid indicator of trauma team activation. J Trauma. 2000;48:1034–7. discussion 1037-1039.

    Article  CAS  PubMed  Google Scholar 

  6. Venereau E, Schiraldi M, Uguccioni M, Bianchi ME. HMGB1 and leukocyte migration during trauma and sterile inflammation. Mol Immunol. 2013;55(1):76–82. pii: S0161-5890(12)00451-8. DOI:10.1016/j.molimm.2012.10.037.

    Article  CAS  PubMed  Google Scholar 

  7. Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006;60:S3–S11.

    Article  PubMed  Google Scholar 

  8. http://www.nationaltraumainstitute.org/home/hemorrhage.html

  9. Kortbeek JB, Al Turki SA, Ali J, Antoine JA, Bouiloon B, Brasel K, et al. Advanced trauma life support, 8th edition, the evidence for change. J Trauma. 2008;64:1638–50.

    Article  PubMed  Google Scholar 

  10. Holcroft JW. Shock. In: Dunphy JE, Way DL, editors. Current surgical diagnosis and treatment. 5th ed. Los Altos, CA: Lange Medical Publication; 1981. p. 172–81.

    Google Scholar 

  11. Bonanno FG. Hemorrhagic shock: the “physiology approach”. J Emerg Trauma Shock. 2012;5(4):285–95. doi:10.4103/0974-2700.102357.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Kauvar DS, Wade CE. The epidemiology and modern management of traumatic hemorrhage: US and international perspectives. Crit Care. 2005;9 Suppl 5:S1–9.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Bouglé A, Harrois A, Duranteau J. Resuscitative strategies in traumatic hemorrhagic shock. Ann Intensive Care. 2013;3(1):1.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Brohi K, Cohen MJ, Davenport RA. Acute coagulopathy of trauma: mechanism, identification and effect. Curr Opin Crit Care. 2007;13:680–5.

    Article  PubMed  Google Scholar 

  15. Brohi K, Cohen MJ, Ganter MT, Schultz MJ, Levi M, Mackersie RC, Pittet JF. Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J Trauma. 2008;64:1211–7. discussion 1217.

    Article  PubMed  Google Scholar 

  16. Floccard B, Rugeri L, Faure A, Denis MS, Boyle EM, Peguet O, Levrat A, Guillaume C, Marcotte G, Vulliez A, Hautin E, David JS, Negrier C, Allaouchiche B. Early coagulopathy in trauma patients: an on-scene and hospital admission study. Injury. 2012;43:26–32.

    Article  PubMed  Google Scholar 

  17. Cohen MJ, Call M, Nelson M, Calfee CS, Esmon CT, Brohi K, Pittet JF. Critical role of activated protein C in early coagulopathy and later organ failure, infection and death in trauma patients. Ann Surg. 2012;255:379–85.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Hess JR, Brohi K, Dutton RP, Hauser CJ, Holcomb JB, Kluger Y, Mackway-Jones K, Parr MJ, Rizoli SB, Yukioka T, Hoyt DB, Bouillon B. The coagulopathy of trauma: a review of mechanisms. J Trauma. 2008;65:748–54.

    Article  CAS  PubMed  Google Scholar 

  19. MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma. 2003;55:39–44.

    Article  PubMed  Google Scholar 

  20. Lippi G, Cervellin G. Disseminated intravascular coagulation in trauma injuries. Semin Thromb Hemost. 2010;36(4):378–87. doi:10.1055/s-0030-1254047.

    Article  PubMed  Google Scholar 

  21. Austin AW, Wirtz PH, Patterson SM, Stutz M, von Känel R. Stress-induced alterations in coagulation: assessment of a new hemoconcentration correction technique. Psychosom Med. 2012;74(3):288–95. doi:10.1097/PSY.0b013e318245d950.

    Article  CAS  PubMed  Google Scholar 

  22. Holowaychuk MK, Monteith G. Ionized hypocalcemia as a prognostic indicator in dogs following trauma. J Vet Emerg Crit Care (San Antonio). 2011;21(5):521–30. doi:10.1111/j.1476-4431.2011.00675.x.

    Article  Google Scholar 

  23. Sihler KC, Raghavendran K, Westerman M, Ye W, Napolitano LM. Hepcidin in trauma: linking injury, inflammation, and anemia. J Trauma. 2010;69(4):831–7. doi:10.1097/TA.0b013e3181f066d5.

    Article  CAS  PubMed  Google Scholar 

  24. Aucar JA, Sheth M. The storage lesion of packed red blood cells affects coagulation. Surgery. 2012;152(4):697–702. doi:10.1016/j.surg.2012.07.011. discussion 702-3.

    Article  PubMed  Google Scholar 

  25. Raza I, Davenport R, Rourke C, Platton S, Manson J, Spoors C, Khan S, De'Ath HD, Allard S, Hart DP, Pasi KJ, Hunt BJ, Stanworth S, MacCallum PK, Brohi K. The incidence and magnitude of fibrinolytic activation in trauma patients. J Thromb Haemost. 2013 Feb;11(2):307-14. doi: 10.1111/jth.12078.

    Google Scholar 

  26. Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H, Gogichaishvili T, Gupta S, Herrera J, Hunt B, Iribhogbe P, Izurieta M, Khamis H, Komolafe E, Marrero MA, Mejia-Mantilla J, Miranda J, Morales C, Olaomi O, Olldashi F, Perel P, Peto R, Ramana PV, Yutthakasemsunt S, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant hemorrhage (CRASH-2): a randomized, placebo-controlled trial. Lancet. 2010;376:23–32.

    Article  CAS  PubMed  Google Scholar 

  27. Davenport R. Pathogenesis of acute traumatic coagulopathy. Transfusion. 2013;53 Suppl 1:23S–7S. doi:10.1111/trf.12032. PMID: 23301969.

    Article  PubMed  Google Scholar 

  28. Frith D, Davenport R, Brohi K. Acute traumatic coagulopathy. Curr Opin Anaesthesiol. 2012;25:229–34.

    Article  PubMed  Google Scholar 

  29. Sawant DA, Tharakan B, Tobin RP, Stagg HW, Hunter FA, Newell MK, Smythe WR, Childs EW. Inhibition of fas-fas ligand interaction attenuates microvascular hyperpermeability following hemorrhagic shock. Shock. 2013;39(2):161–7. doi:10.1097/SHK.0b013e31827bba73.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. McGhan LJ, Jaroszewski DE. The role of toll-like receptor-4 in the development of multi-organ failure following traumatichaemorrhagic shock and resuscitation. Injury. 2012;43(2):129–36. doi:10.1016/j.injury.2011.05.032.

    Article  PubMed  Google Scholar 

  31. Xiang M, Fan J, Fan J. Association of Toll-like receptor signaling and reactive oxygen species: a potential therapeutic target for posttrauma acute lung injury. Mediators Inflamm. 2010. pii: 916425. DOI: 10.1155/2010/916425

  32. Bonanno FG. Physiopathology of shock. J Emerg Trauma Shock. 2011;4(2):222–32.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Schumacker PT, Samsel RW. Oxygen delivery and uptake by peripheral tissues: physiology and pathophysiology. Crit Care Clin. 1989;5:255–69.

    CAS  PubMed  Google Scholar 

  34. http://www.jblearning.com/samples/0763740411/Ch%202_Seaward_Managing%20Stress_5e.pdf

  35. Klengel T, et al. Allele-specific FKBP5 DNA demethylation mediates gene–childhood trauma interactions. Nature Neurosci. 2013;16:33–41. doi:10.1038/nn.3275.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Lindahl AE, Low A, Stridsberg M, Sjöberg F, Ekselius L, Gerdin B. Plasma chromogranin A after severe burn trauma. Neuropeptides. 2013;47(3):207–12. pii: S0143-4179(12)00109-6. DOI: 10.1016/j.npep.2012.10.004.

    Article  CAS  PubMed  Google Scholar 

  37. Ahn Y, Görlinger K, Alam HB, Eikermann M. Pain-associated respiratory failure in chest trauma. Anesthesiology. 2013;118(3):701–8.

    Article  PubMed  Google Scholar 

  38. Shibata M, Hanzawa K, Ueda S, Yambe T. Deep venous thrombosis among disaster shelter inhabitants following the March 2011 earthquake and tsunami in Japan: a descriptive study. Phlebology. 2014;29(4):257–66.

    Article  CAS  PubMed  Google Scholar 

  39. Rosenbloom BN, Khan S, McCartney C, Katz J. Systematic review of persistent pain and psycho- logical outcomes following traumatic musculoskeletal injury. J Pain Res. 2013;6:39–51. doi:10.2147/JPR.S38878.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Griffis CA, Crabb Breen E, Compton P, Goldberg A, Witarama T, Kotlerman J, Irwin MR. Acute painful stress and inflammatory mediator production. Neuroimmunomodulation. 2013;20(3):127–33.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Xu Z, Li Y, Wang J, Li J. Effect of postoperative analgesia on energy metabolism and role of cyclooxygenase-2 inhibitors for postoperative pain management after abdominal surgery in adults. Clin J Pain. 2013;29(7):570–6.

    Article  PubMed  Google Scholar 

  42. Chaudry IH, Ayala A. Mechanism of increased susceptibility to infection following hemorrhage. Am J Surg. 1993;165(2A Suppl):59SY67S.

    Google Scholar 

  43. Mollen KP, Anand RJ, Tsung A, Prince JM, Levy RM, Billiar TR. Emerging paradigm: toll-like receptor 4 sentinel for the detection of tissue damage. Shock. 2006;26(5):430Y437.

    Article  Google Scholar 

  44. Kobbe P, Kaczorowski DJ, Vodovotz Y, Tzioupis CH, Mollen KP, Billiar TR, Pape HC. Local exposure of bone components to injured soft tissue induces toll-like receptor 4Ydependent systemic inflammation with acute lung injury. Shock. 2008;30(6):686Y691.

    Article  Google Scholar 

  45. Zhang Q, Raoof M, Chen Y, Sumi Y, Sursal T, Junger W, Brohi K, Itagaki K, Hauser CJ. Circulating mitochondrial DAMPs cause inflammatory responses to injury. Nature. 2010;464:104Y107.

    Google Scholar 

  46. Cai C, Gill R, Eum HA, Cao Z, Loughran PA, Darwiche S, Edmonds RD, Menzel CL, Billiar TR. Complement factor 3 deficiency attenuates hemorrhagic shock related hepatic injury and systemic inflammatory response syndrome. Am J Physiol Regul Integr Comp Physiol. 2010;299(5):R1175YR1182.

    Article  Google Scholar 

  47. Sobhian B, Kröpfl A, Hölzenbein T, Khadem A, Redl H, Bahrami S. Increased circulating D-lactate levels predict risk of mortality after hemorrhage and surgical trauma in baboons. Shock. 2012;37(5):473–7. doi:10.1097/SHK.0b013e318249cb96.

    Article  CAS  PubMed  Google Scholar 

  48. Nieves E, Tobón LF, Ríos DI, Isaza A, Ramírez M, Beltrán JA, Garzón-Ospina D, Patarroyo MA, Gómez A. Bacterial translocation in abdominal trauma and postoperative infections. J Trauma. 2011;71(5):1258–61.

    Article  PubMed  Google Scholar 

  49. Sánchez-Aguilar M, Tapia-Pérez JH, Sánchez-Rodríguez JJ, Viñas-Ríos JM, Martínez-Pérez P, de la Cruz-Mendoza E, Sánchez-Reyna M, Torres-Corzo JG, Gordillo-Moscoso A. Effect of rosuvastatin on cytokines after traumatic head injury. J Neurosurg. 2013;118(3):669–75.

    Article  PubMed  Google Scholar 

  50. Francis WR, Bodger OG, Pallister I. Altered leucocyte progenitor profile in human bone marrow from patients with major trauma during the recovery phase. Br J Surg. 2012;99(11):1591–9. doi:10.1002/bjs.8919.

    Article  CAS  PubMed  Google Scholar 

  51. Marik PE, Pastores SM, Annane D, Meduri U, Sprung CL, Arlt W, Keh D, Briegel J, Beishuizen A, Dimopoulou I, et al. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008;36:1937–49.

    Article  CAS  PubMed  Google Scholar 

  52. Annane D, Maxime V, Ibrahim F, Alvarez JC, Abe E, Boudou P. Diagnosis of adrenal insufficiency in severe sepsis and septic shock. Am J Respir Crit Care Med. 2006;174:1319–26.

    Article  PubMed  Google Scholar 

  53. Maxime V, Lesur O, Annane D. Adrenal insufficiency in septic shock. Clin Chest Med. 2009;30:17–27.

    Article  PubMed  Google Scholar 

  54. Stein DM, Jessie EM, Crane S, Kufera JA, Timmons T, Rodriguez CJ, Menaker J, Scalea TM. Hyperacute adrenal insufficiency after hemorrhagic shock exists and is associated with poor outcomes. J Trauma Acute Care Surg. 2013;74(2):363–70. doi:10.1097/TA.0b013e31827e2aaf.

    Article  CAS  PubMed  Google Scholar 

  55. Miller JB, Donnino MW, Rogan M, Goyal N. Relative adrenal insufficiency in post-cardiac arrest shock is under-recognized. Resuscitation. 2008;76(2):221–5.

    Article  PubMed  Google Scholar 

  56. Thiemermann C, Szabo C, Mitchell JA, Vane JR. Vascular hyporeactivity to vasoconstrictor agents and hemodynamic decompensation in hemorrhagic shock is mediated by nitric oxide. Proc Natl Acad Sci U S A. 1993;90:267Y271.

    Article  Google Scholar 

  57. Hierholzer C, Harbrecht B, Menezes JM, Kane J, MacMicking J, Nathan CF, Peitzman AH, Billiar TR, Tweardy DJ. Essential role of induced nitric oxide I the initiation of the inflammatory response after hemorrhagic shock. J Exp Med. 1998;187(6):917Y928.

    Article  Google Scholar 

  58. Darwiche SS, Pfeifer R, Menzel C, Ruan X, Hoffman M, Cai C, Chanthaphavong RS, Loughran P, Pitt BR, Hoffman R, Pape HC, Billiar TR. Inducible nitric oxide synthase contributes to immune dysfunction following trauma. Shock. 2012;38(5):499–507. doi:10.1097/SHK.0b013e31826c5afe.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  59. Williams VL, Martin RE, Franklin JL, Hardy RW, Messina JL. Injury-induced insulin resistance in adipose tissue. Biochem Biophys Res Commun. 2012;421(3):442–8. doi:10.1016/j.bbrc.2012.03.146.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  60. Xu H, Yu YM, Ma H, Carter EA, Fagan S, Tompkins RG, Fischman AJ. Glucose metabolism during the early “flow phase” after burn injury. J Surg Res. 2013;179(1):e83–90. doi:10.1016/j.jss.2012.02.037.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  61. Jeter CB, Hergenroeder GW, Hylin MJ, Redell JB, Moore AN, Dash PK. Biomarkers for the diagnosis and prognosis of mild traumatic brain injury/ concussion. J Neurotrauma. 2013;30(8):657–70.

    Article  PubMed  Google Scholar 

  62. Tenenbein P, Kincaid MS, Lam AM. Head trauma-anesthetic considerations and management. In: Smith C, editor. Trauma anesthesia. Cambridge: Cambridge University Press; 2008. Chapter 11.

    Google Scholar 

  63. van Wessem KJ, Hennus MP, van Wagenberg L, Koenderman L, Leenen LP. Mechanical ventilation increases the inflammatory response induced by lung contusion. J Surg Res. 2013;183(1):377–84. pii: S0022-4804(12)01986-5. DOI:10.1016/j.jss.2012.12.042.

    Article  PubMed  Google Scholar 

  64. Easter A. Management of patients with multiple rib fractures. Am J Crit Care. 2001;10(5):320–7.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Tulane University Medical Center, 1430 Tulane Avenue, SL-4, New Orleans, LA, 70112, USA

    Henry Liu M.D., Seth Christian M.D., Santiago Gomez M.D. & Frank Rosinia M.D.

  2. Department of Anesthesiology, Wuhan Central Hospital, 26 Shengli Street, Wuhan, 430014, China

    Hong Yan M.D.

  3. Department of Anesthesiology, Wuhan Tongji Hospital, 1095 Jiefang Avenue, Wuhan, 430030, China

    Mingbing Chen M.D., Ph.D. & Juan Tan M.D., Ph.D.

  4. Department of Anesthesiology, LSUHSC-Shreveport, 1501 Kings Highway, Shreveport, LA, 71102, USA

    Charles J. Fox M.D.

  5. Department of Anesthesiology and Department of Pharmacology, Pain Services, LSU School of Medicine T6M5, 1542 Tulane Avenue, Room 656, New Orleans, LA, 70112, USA

    Alan David Kaye M.D., Ph.D., D.A.B.A., D.A.B.P.M., D.A.B.I.P.P.

Authors
  1. Henry Liu M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hong Yan M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seth Christian M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Santiago Gomez M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frank Rosinia M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mingbing Chen M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Juan Tan M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Charles J. Fox M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alan David Kaye M.D., Ph.D., D.A.B.A., D.A.B.P.M., D.A.B.I.P.P.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Henry Liu M.D. .

Editor information

Editors and Affiliations

  1. Bellevue Hospital Center, New York University, New York, New York, USA

    Corey S. Scher

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Liu, H. et al. (2014). Physiological Derangement of the Trauma Patient. In: Scher, C. (eds) Anesthesia for Trauma. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0909-4_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-0909-4_3

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-0908-7

  • Online ISBN: 978-1-4939-0909-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation