Editing Trauma - ICU phase


== Resuscitative phase ==

* Restoration of body temperature
* Optimisation of oxygen delivery
* Correction of clotting profiles
* Improvement of physiological endpoints
* Monitoring for, and minimising, IAH and ACS
* Recognition of additional injuries

== Early life support (24-72 hours) ==

* Management of post-traumatic respiratory failure
* Search for occult injuries
* Nutritional support
* Establish medical history, mechanism of injury
* Intra-cranial hypertension
* SIRS
* MODS
* Prophylaxis
** PPI
** Enoxaparin
** Consider IVC filter

== >72 hours (prolonged life support) ==

* Indicates more serious injury, if present
* Provide organ support
* Isolate and eliminate inflammatory foci
* Avoid infectious complications

== Metabolic response to trauma ==

* Ebb - during severe illness
** Pro-inflammatory response can predominate - SIRS, shock
*** TNF, IL-1, IL-8 triggered by actual tissue damage; DAMPs (damage associated molecular patterns) released from damaged cells (c.f. PAMPs with infection)
*** Pro-coagulant
*** Activate neutrophils, etc
*** Generation of free radicals
** Cortisol, vasopressin, aldosterone and glucagon up
** Water and salt retention
* Flow - during recovery
** Pro-inflammatory pathway should subside, replaced by a hyperdynamic/hypermetabolic state
** Higher insulin, but also higher glucose
** Higher catecholamines
** Increased cardiac output
** Higher temperature

[[Category:Trauma]]