Traumatic shock

The definition of traumatic shock as inadequate organ perfusion after a trauma involves widely varying pathophysiological mechanisms and their clinical ramifications for early multiple trauma treatment. The actual mediator- or toxin-induced circulatory dysregulation often cannot be differentiated from the hypovolaemic and neurogenic shock in the early phase. Traumatic shock leads to a massive activation of the sympathico-adrenergic system and resulting compensation mechanisms. It has been possible in clinical and experimental studies to s how that there are both pro-inflammatory and anti-inflammatory reactions immediately after the trauma, and that there is a significant correlation between their extent in the first few hours and days and the prognosis. Every surgical trauma precipitates an additive shock event ("second hit"), which means a policy of performing no more than damage control surgery in the early hours and days. Ín other words, in practice acutely life-threatening injuries only should be treated, and that with the least elaborate procedures possible, and in particular damage control orthopaedic techniques should be applied for primary stabilisation of fractures by minimally invasive procedures, with definitive stabilisation subsequently by secondary interventions. © 2006 Springer Medizin Verlag.