Systemic responses to trauma.

The systemic responses to trauma can be divided into cardiovascular, immunological, and metabolic. The cardiovascular responses are seen immediately after a traumatic insult. The pattern of response depends on whether the insult is mainly haemorrhagic, tissue damage, or a combination of the two. The response may be quite different for penetrating vascular trauma, compared with a crush injury to a limb. The immunological, or inflammatory, consequences of trauma usually become apparent several hours or days after the initial insult, although it is increasingly clear that they may be triggered by the very early cardiovascular changes. These have been implicated in the development of multiple organ failure. The metabolic responses are of greatest importance in the longer term: after successful resuscitation and after the definitive treatment of the patient's injuries. The metabolic responses need to be taken into account during the recovery from treatment and during the rehabilitation of the patient.