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From Trauma Scoring System to Early Appropriate Care

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Operative Techniques and Recent Advances in Acute Care and Emergency Surgery

Abstract

Trauma is still the main cause of mortality in Western countries. Patients die as a direct consequence of major trauma or by additional damage due to the immune reaction. Mortality is due to a first hit (trauma load) or second hit (interventional load) related to the immune response and medical treatment. In this chapter, we focus on the pathophysiology of the reaction of the human body to trauma, the primary scoring systems used in medical practice and how to use them in the effort to improve mortality and morbidity in trauma patients. After trauma, a pro-inflammatory systemic reaction (SIRS) is induced by pro-inflammatory cytokines. To restore the equilibrium of an excessive pro-inflammatory reaction, an anti-inflammatory response is induced, and in favourable cases, the homeostasis can be achieved. An overreaction of the anti-inflammatory response can lead to either a compensatory anti-inflammatory response (CARS) or a mixed antagonist response (MARS). The amount of the injury to the host can be expressed in scoring systems, and these have become important prognostic tools to calculate the risk based on clinical signs and symptoms in combination with inflammatory parameters when a threshold has been reached before clinical symptoms become evident. Medical trauma team has to deal with the decision to choose the right strategy and right timing to improve mortality and morbidity.

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Author information

Authors and Affiliations

  1. Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano, Niguarda Ca’ Granda Hospital, Milan, MI, Italy

    Anna Mariani

  2. Anesthesia and Intensive Care 1, ASST Grande Ospedale Metropolitano Niguarda, Milan, MI, Italy

    Gianpaolo Casella

  3. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Paolo Aseni

Authors
  1. Anna Mariani
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  2. Gianpaolo Casella
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  3. Paolo Aseni
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Editor information

Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Milano, Italy

    Paolo Aseni

  2. School of Medicine, University of Milano-Bicocca, Niguarda Hospital, Milan, Milano, Italy

    Luciano De Carlis

  3. Department of Cardiac Surgery, IRCCS MultiMedica, Milan, Milano, Italy

    Alessandro Mazzola

  4. Department of Cardiac Surgery, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy

    Antonino M. Grande

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Mariani, A., Casella, G., Aseni, P. (2019). From Trauma Scoring System to Early Appropriate Care. In: Aseni, P., De Carlis, L., Mazzola, A., Grande, A.M. (eds) Operative Techniques and Recent Advances in Acute Care and Emergency Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-95114-0_9

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  • DOI: https://doi.org/10.1007/978-3-319-95114-0_9

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-95113-3

  • Online ISBN: 978-3-319-95114-0

  • eBook Packages: MedicineMedicine (R0)

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