Management of shock in trauma

Publication date: September 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 9 Author(s): Jonathan D. Pearson , Jonathan A. Round , Michael Ingram Shock is failure of the circulatory system to provide the organ perfusion and tissue oxygenation required to meet cellular metabolic demands. Traumatic shock is most commonly associated with haemorrhage, although it is recognized the trauma patient may present with non-haemorrhagic shock. The ‘lethal triad’ of metabolic acidosis, hypothermia, and acute coagulopathy seen in trauma patients has been fundamental to the development of the current approach to management of traumatic shock. Damage control resuscitation encompasses key resuscitative strategies including hypotensive resuscitation, the use of blood and blood products as primary resuscitative fluids to correct coagulopathy, maintain organ perfusion and restore tissue oxygenation and damage control surgery. Such resuscitation strategies, delivered through established protocols and centralization of trauma services have been revolutionary in the management of the shocked trauma patient. Current focus is on evolving and refining these strategies including identifying the subsets of patients at greatest risk as early as practicable following injury. Delivering trauma care, with an experienced team working in a ‘horizontal’ clinical approach and meeting key performance indicators has been shown to improve outcome when managing the shocked...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research