Resuscitation of Trauma Patients

  • A. Gullo
  • G. Berlot
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 23)


In Western countries trauma is the leading cause of mortality and disability among those aged under 30 years [1]. According to official statistics only in Italy do more than 8000 people die every year in road accidents, and many more remain severely disabled. While there are differences in the types of injuries between the United States and Europe (basically much more frequent open trauma, such as gunshot and stab wounds, in the former), this epidemic entails extremely high human, economic, and social costs. It is conceivable that a more comprehensive diagnostic and therapeutic approach could reduce this burden.


Trauma Patient Hemorrhagic Shock Advance Trauma Life Support Gastric Tonometry Torso Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Trunkey DD (1983) Trauma. Sci Ann 282:298–235Google Scholar
  2. 2.
    Trunkey DD (1991) Initial treatment of patients with severe trauma. N Engl J Med 324:1259–1263PubMedCrossRefGoogle Scholar
  3. 3.
    Stocchetti N, Pagliarini G, Gennari M et al (1994) Trauma care in Italy: evidence of in-hospital preventable deaths. J Trauma 36:401–405PubMedCrossRefGoogle Scholar
  4. 4.
    Weissman C (1990) The metabolic response to stress: an overview and update. Anesthesiology 73:308–327PubMedCrossRefGoogle Scholar
  5. 5.
    Fink MP (1991) Gastrointestinal mucosal injury in experimental models of shock, trauma and sepsis. Crit Care Med 19:627–641PubMedCrossRefGoogle Scholar
  6. 6.
    Ruomen RMH, Vreugde JPC, Goris J A (1994) Gastric tonometry in multiple trauma patients. J Trauma 36:313–316CrossRefGoogle Scholar
  7. 7.
    Chang MC, Cheatham ML, Nelson LD, Rutherford EJ, Morris JA (1994) Gastric tonometry supplements information provided by systemic indicators of oxygen transport. J Trauma 37(3): 488–494PubMedCrossRefGoogle Scholar
  8. 8.
    Doglio GR, Pusajo JF, Egurrola MA et al (1991) Gastric mucosal pH as a prognostic index of mortality in critically ill patients. Crit Care Med 19:1037–1040PubMedCrossRefGoogle Scholar
  9. 9.
    Gutierrez G, Palizas F, Doglio G et al (1992) Gastric intramucosal pH as a therapeutic index of tissue oxygenation in critically ill patients. Lancet 339:195–199PubMedCrossRefGoogle Scholar
  10. 10.
    Maynard N, Bihari D, Beale R et al (1993) Assessment of splanchnic oxygenation by gastric tonometry in patients with acute circulatory failure. JAMA 270:1203–1210PubMedCrossRefGoogle Scholar
  11. 11.
    Grace PA (1994) Ischemia-reperfusion injury. Br J Surg 81:637–647PubMedCrossRefGoogle Scholar
  12. 12.
    Deitch EA (1992) Multiple organ failure: pathophysiology and potential future therapy. Ann Surg 216:117–134PubMedCrossRefGoogle Scholar
  13. 13.
    Morris SE, Navaratnam T, Townsend CM et al (1989) Decreased mesenteric blood flow independently promotes bacterial translocation in chronically instrumented sheep. Surg Forum 40:88–92Google Scholar
  14. 14.
    Jones WG II, Minei JP, Barber AE et al (1990) Bacterial translocation and intestinal atrophy after thermal injury and burn wound sepsis. Ann Surg 211:399–403PubMedCrossRefGoogle Scholar
  15. 15.
    Edmiston CE, Condon RE (1991) Bacterial translocation. Surg Gynecol Obstet 173:73–83PubMedGoogle Scholar
  16. 16.
    Rush BF, Sori AJ, Murphy TF, Smith S, Flanagan JJ, Machiedo GW (1987) Endotox- emia and bacteremia during hemorrhagic shock. The link between trauma and sepsis? Ann Surg 207:549–554CrossRefGoogle Scholar
  17. 17.
    Reed L, Martin M, Mangano R, Newson B, Kocka F, Barrettt J (1994) Bacterial translocation following abdominal trauma in humans. Circ Shock 42:1–6PubMedGoogle Scholar
  18. 18.
    Andersen LW, Landow L, Baek L, Jansen E, Baker S (1993) Association between gastric imtramucosal pH and splanchnic endotoxin antibody to endotoxin and tumour necrosis factor concentration in patients undergoing cardiopulmonary bypass. Crit Care Med 21:210–217PubMedCrossRefGoogle Scholar
  19. 19.
    Takayama TK, Miller C, Szabo G (1990) Elevated tumour necrosis factor production concomitant to elevated prostaglandin E2 production by trauma patient's monocytes. Arch Surg 125:29–35PubMedGoogle Scholar
  20. 20.
    Marano MA, Fong Y, Moldawer LL et al (1990) Serum cachectin/tumour necrosis factor in critically ill patients with burns correlates with infection and mortality. Surg Gynecol Obstet 170:32–38PubMedGoogle Scholar
  21. 21.
    Hoch RC, Rodriguez R, Manning T et al (1993) Effects of accidental trauma on cytokine and endotoxin production. Crit Care Med 21:869–845CrossRefGoogle Scholar
  22. 22.
    Abraham E (1989) Host defense abnormalities after hemorrhage, trauma and burns. Crit Care Med 17:934–939PubMedCrossRefGoogle Scholar
  23. 23.
    Schmand JF, Ayala A, Chaudry IH (1994) Effects of trauma, duration of hypotension, and resuscitation regimen on cellular immunity after hemorrhagic shock. Crit Care Med 2:1076–1083CrossRefGoogle Scholar
  24. 24.
    McCord JM (1985) Oxygen-derived free radicals in postischemic tissue injury. N Engl J Med 312:159–163PubMedCrossRefGoogle Scholar
  25. 25.
    Berlot G, Viviani M, Gullo A (1992) Traumatic carotideal dissection after blunt cervical injury: an elusive clinical entity. Am J Emerg Med 10(4): 396–398PubMedCrossRefGoogle Scholar
  26. 26.
    Berlot G, Viviani M, Magnaldi S, Gullo A (1995) Delayed traumatic cervical cord transection: case report. Am J Emerg Med (in press)Google Scholar
  27. Marshall LF, Bowers Marshall S, Klauber MR et al: A new classification of head injury based on computed tomography. J Neurosurg 119(75):S14-S20Google Scholar
  28. 28.
    Anonymous (1992) Standards and Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) JAMA 268 (16): 2172–2298Google Scholar
  29. 29.
    Brickell H, Wall MJ, Pepe PE et al (1994) Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso trauma. N Engl J Med 331:1105–1109CrossRefGoogle Scholar
  30. 30.
    American College of Surgeons, Committee on Trauma (1993) Advanced trauma life support program for physicians: instructor manual. American College of Surgeons, Chicago, pp 75–110Google Scholar
  31. 31.
    Falk JL, O’Brien JF, Kerr R (1992) Fluid resuscitation in traumatic hemorrhagic shock. Crit Care Clin 8:323–340PubMedGoogle Scholar
  32. 32.
    Dawson RB (1987) Transfusion: volume expansion, oxygen transport, hemostasis, transufion reactions, autotransfusion. In: Cowley RA, Conn A, Dunham CM (eds) Trauma care: medical management. Lippincott, New York, p 131Google Scholar
  33. 33.
    Seibel R, LaDuca J, Hassett JM et al (1985) Blunt multiple trauma (ISS), femur traction and the pulmonary failure syndrome. Ann Surg 202:283–295Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • A. Gullo
  • G. Berlot

There are no affiliations available

Personalised recommendations