Sesh 7.2- Pathology Of Trauma

Question 1

What are the 4 general effects of trauma?

Answer 1

1. Bleeding
2. Infection and sepsis
3. Specific organ/system effects
4. Multi-organ failure

Question 2

What is a diffuse axonal injury commonly caused by?

Answer 2

A deceleration injury e.g. Head struck in car accident/ with object, causing axons to break

Question 3

List some complications of head injury.

Answer 3

• Raised intracranial P- will put P on centres controlling resp and cardiac function in brainstem
• Generalised effects- reduced Glasgow coma score
• Specific neurological defects
• Infection- skull fractures or penetrating wounds

Question 4

If intercostal arteries become damaged in a rib fracture, what can result?

Answer 4

Haemothorax

Question 5

Give 4 types of abdominal trauma

Answer 5

1. Liver laceration
2. Spleen laceration
3. Intestinal perforation
4. Pancreatic injury

Question 6

What is the main complication associated with pelvis fractures?

Answer 6

Severe internal haemmorhage- bp will drop, so need fluid then blood

Question 7

Give 4 possible complications of long bone fracture.

Answer 7

1. Bleeding
2. Vascular damage
3. Nerve damage
4. Fat embolism

Question 8

Name 4 types of trauma that can give rise to vascular injury.

Answer 8

1. Stabwounds
2. Gunshot wounds
3. Impalement
4. Plate glass accidents

Question 9

What are the main complications of crush injuries?

Answer 9

1. Tissue loss- can result in amputation
2. Fractures- will be v small fragments
3. Vascular injury
4. Compartment syndromes- compromises blood supply-ischaemia
5. Rhabdomyolysis- skel muscle damage–>myoglobin released and affects kidney function

Question 10

What is the ‘rule of 9’s’ in relation to burns?

Answer 10

Used to give estimate of % of body affected, for prognosis and to calc fluid loss etc.
E.g. Head=9%; 1 leg=9%

Question 11

What are some of the systemic effects of burns?

Answer 11

• Release of cytokines and inflam mediators
• Fluid loss
• Reduced myocardial contractility- hypotension and hypoperfusion- ischaemic damage
• Metabolic rate massively increases
• Non-specific down-regulation of immune response

Question 12

Why is aggressive enteral feeding required for burns victims?

Answer 12

Their metabolic rate has massively increased, so need to feed to reduce catabolism and maintain GIT integrity.

Question 13

Why are burns victims susceptible to infection?

Answer 13

• Get non-specific down-regulation of immune response

- Lost part of skin barrier

Question 14

What are the systemic effects of haemorrhage?

Answer 14

• Hypovolaemic shock

- Reduce CO–> hypoperfusion–> tissue ischaemia/ hypoxia

Question 15

What is SIRS?

Answer 15

Systemic inflammatory response syndrome- the body’s response to infection, inflammation and/or stress (i.e. Trauma).

Question 16

What are the criteria for SIRS?

Answer 16

Must have at least 2 of:

• temp >38.5 or <36 C
• HR> 90bpm
• RR >20 bpm or PaCO2 <32 mmHg
• WBC >12,000 cells/mm3, <4, 000 cells/mm3 or >10% immature

Question 17

What is the difference between sepsis and SIRS?

Answer 17

Sepsis= SIRS + confirmed or suspected infection

Question 18

What is the difference between sepsis and severe sepsis?

Answer 18

Severe sepsis= sepsis + 1/ more signs of organ dysfunction

Question 19

What are some of the clinical features of sepsis/ severe sepsis?

Answer 19

• Areas of mottled skin
• DIC
• Long cap refill
• AKI
• Low urine outputt
• Acute resp distress syndrome
• Lactate >2mmol/L
• Cardiac dysfunction -Tn leak
• Altered mental status- abn EEG
• Platelets <100

Question 20

What is acute respiratory distress syndrome?

Answer 20

Results from acute lung injury

• Damage/death of pneumocytes
• Oedema
• Neutrophils migrate into alveoli and release proteases

Question 21

What is septic shock?

Answer 21

Sepsis plus 1 of:

• MAP <60 mmHg after adequate fluid resuscitation
• Need inotropes (e.g. NA) to maintain bp after fluid resuscitation
• Lactate >4 mmol/L

Question 22

Patients with multi-organ failure/ dysfuction syndrome become ____________ and _______________.

Answer 22

1. Hypometabolic

2. Immunodepressed

Question 23

What are the mechanisms behind MODS?

Answer 23

• Genetics
• Co-morbidities
• Treatments e.g. O2 therapy can damage circulation
• Circulation
• Inflammatory mediators are key
• Coagulation system is inappropriately activated

Question 24

How may MODS present?

Answer 24

• AKI- acidosis, uraemia
• Acute resp distress syndrome- impaired gas exch, increased O2 need
• Cardiac dysfunction- reduced CO, hypotension
• Encephalopathy- reduced conscious level
• GI disturbance- e.g. Paralytic ileus
• Liver dysfunction- low albumin, jaundice
• Coagulopathy- DIC
• Bone marrow suppression