Body Response to Trauma

1. Body Response to Trauma Dr. Hassan Bukhari Depart of Surgery Sept. 18, 2011

2. Objectives • By the end of this discussion, you will be able to: • Define Stress (body) response to trauma • Identify different types of response to trauma • Recognize the manifestation of stress response • Apply your understanding of this response in patient’s care

3. Contents • MCQ / scenarios – based lecture • Definition of stress (body) response to trauma • Types of systemic response to trauma • Sympathetic • Hormonal / metabolic • Immunological

4. Body (stress) response Defined as a group of hormonal, metabolic and immunological changes following injury or trauma

5. Systemic response* • Sympathetic nervous system activation • Hormonal • Pituitary hormones secretion • Insulin resistance • Immunological • Cytokines production • Acute phase response • Neutrophilleukocytosis • Lymphocyte prolifiration *Br J Anaesth 2000.

6. Hypothalamic –Pituitary adrenal (HPA) system

8. MCQ # 1 • Secretion of all the following hormones will increase following trauma EXCEPT: 1- Cortisol 2- Vassopressin (VP) 3- Glucagon 4- Insulin 5- Growth Hormone (GH) 6- Aldosterone 7- Prolactin ✓

9. Hormonal / Metabolic response • The endpoint effect of this response is • Catabolism  provide energy • Protein break down (late) • Lipolysis • Inhibit glucose uptake by cells • Retaining of water and salt  maintain fluid volume and CV stability.

10. Pituitary gland hormones?

11. Adrenal gland hormones?

12. Other hormones

13. MCQ # 2 • All are the endpoints of hormonal secretion following trauma EXCEPT: 1- Glycogenolysis 2- Gluconeogenesis 3- Hypoglycemia 4- Proteinolysis 5- Lipolysis ✓

14. Systemic response* • Sympathetic nervous system activation • Hormonal • Immunological • Cytokines production • Acute phase reaction • Neutrophilleukocytosis • Lymphocyte prolifiration *Br J Anaesth 2000.

15. Immunological Response • Cell-Mediated response • Macrophages will release cytokines • Cytokines • Are Proteins (Interleukins and interferons) • Major role in local and systemic effects • Promotes acute phase response

17. MCQ # 3 • What is true and false about cytokines following trauma? 1- IL-1, IL-6 and TNF-α are the most important cytokines 2- They are released from lymphocytes 3- TNF-α is the main cytokines responsible for acute phase response 4- IL-1 and IL-6 reduce cortisol secretion 5- The level of C-reactive protein (CRP) and fibrinogen is increased 6- The Level albumin and transferrin is increased ✓ ✗ ✗ ✗ ✓ ✗

18. Two important Syndromes • Systemic inflammatory response syndrome (SIRS) • Inflammatory mediators • Compensatory anti-inflammatory response syndrome (CARS) • Anti-inflammatory mediators SIRS CARS

19. SIRS • Defined as generalized inflammatory response triggered by infectious and noninfectious events. • Clinical manifestation (at least 2 out of 4) • HR >90 • RR > 20 • Temp > 38°C or <36°C • WBC >12,000 or < 4000. • This syndrome is opposed by CARS

20. SIRS vs. CARS

21. MCQ # 4 • All are clinical manifestation of body response to trauma EXCEPT: 1- Tachycardia 2- Fever 3- Tachypnea 4- vasodilatation 5- leukocytosis ✓

22. Immunological Response

23. Any Question

24. In Summary • Definition of stress (body) response to trauma • Types of systemic response to trauma and its effects • Sympathetic • Hormonal / metabolic • Immunological • Clinical manifestation • SIRS vs. CARS

25. References • Desborough JP. The Stress Response to Trauma and Surgery. Br J Anaesth 2000, 85:109-17. • www.youtube.com • Asensio JA, Trunkey D. Current Therapy of Trauma and Surgical Critical Care. Philadilphia: Mosby-Elsevier,2008