Emergency War Surgery NATO Handbook: Part II: Response of the Body to Wounding: Chapter X: Compensatory and Pathophysiological Responses to Trauma
United States Department of Defense
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The magnitude of the systemic response to trauma is proportional to the extent of the injury and the local changes at the site of injury. The response is biphasic, with early post-injury hypofunction followed by later hyperfunction in most organ systems. The acute phase is characterized by progressive circulatory insufficiency, decreasing cardiac output, decreasing oxygen consumption, developing acidosis, and discharge of the adrenergic nervous system. If adequate resuscitation is provided, a chronic hyperdynamic, hypermetabolic state persists until resolution of the traumatic injury and any post-traumatic complications. This phase is characterized by an increase in cardiac output and oxygen consumption, tachycardia, and negative nitrogen balance with depletion of lean body mass. This response occurs following a variety of injuries and is modified by any pre-existing metabolic disorder or post-traumatic complications that may arise.
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