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A current concept of trauma-induced multiorgan failure
C C Lee1, K A Marill, W A Carter
1Department of Emergency Medicine, Flushing Hospital Medical Center, 45th Avenue at Parsons Boulevard, Flushing, NY 11355, USA. flushingerdoc@aol.com
Annals of Emergency Medicine
|July 27, 2001
Summary
Trauma deaths follow a trimodal pattern. Inadequate resuscitation in the emergency department can trigger a cascade leading to systemic inflammatory response syndrome and fatal multiple organ failure.
Area of Science:
- Trauma and Emergency Medicine
- Critical Care Medicine
- Pathophysiology
Background:
- Trauma deaths exhibit a trimodal distribution: immediate, early (within 24 hours), and late (3-4 weeks).
- Inadequate resuscitation in emergency departments can precipitate acidosis, hypothermia, and coagulopathy.
- The progression to multiple organ failure is understood as a continuum driven by inflammation.
Purpose of the Study:
- To discuss the pathophysiology, diagnosis, prevention, and treatment of multiple organ failure following traumatic injury.
- To elucidate the continuum from initial shock response to systemic inflammatory response syndrome and organ failure.
Main Methods:
- Review of existing literature on trauma, shock, and inflammatory response.
- Discussion of pathophysiologic mechanisms.
- Analysis of diagnostic and therapeutic strategies.
Main Results:
- Failure to achieve adequate resuscitation is a critical factor in early mortality.
- Inflammation and inflammatory mediators play a central role in perpetuating organ failure.
- The development of multiple organ failure is a progressive process initiated by the initial injury and resuscitation response.
Conclusions:
- Understanding the inflammatory cascade is crucial for managing trauma patients.
- Effective initial resuscitation is paramount to prevent progression to multiple organ failure.
- Comprehensive strategies for diagnosis, prevention, and treatment are needed for traumatic injury-induced multiple organ failure.