Special Problems in the Critically Ill Trauma Patient
Resuscitation consists of many interrelated and often protracted activities that are directed toward reversal of the shock state. Shock is a physiologic state, not just an abnormal hemodynamic state. It is best defined as a condition in which systemic oxygen delivery is inadequate for normal aerobic metabolic needs. Shock can be classified as hypovolemic, cardiogenic, neurogenic, or vasogenic. Traumatized patients can present in any of these states but most often present with hypovolemic shock secondary to acute blood loss due to bleeding, that is, hemorrhagic shock. Although resuscitation of the injured patient is usually accomplished in the Emergency Department (ED), or during emergent operative procedures, it is not uncommon for a traumatized patient to arrive in the intensive care unit (ICU) in an underresuscitated condition. Most often this is a result of inadequate volume replacement during the initial resuscitation; however, the presence of continued blood loss from occult undiagnostic injuries must always be considered.
KeywordsTrauma Patient Deep Venous Thrombosis Compartment Syndrome Abdominal Compartment Syndrome Massive Transfusion
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