[Multi-trauma patients undergoing shock management]. / Le patient polytraumatisé en situation de "déchocage".

Multi-trauma patients need specific care provided by medical teams and hospitals with a technical platform that optimises emergency care.They also require a special 'shock management' unit with staff members available to welcome these patients and maintain their vital functions.

Traumatic shock: the fifth shock.

Although, historically, shock associated with traumatic injury has been evaluated through knowledge of the 4 recognized shock patterns--cardiogenic, obstructive, distributive, and hypovolemic--many trauma practitioners view traumatic shock as a unique fifth shock pattern. Although secondary to a systemic inflammatory response syndrome triggered by endogenous danger signals, traumatic shock represents a unique pathological condition that begins with multiple, usually blunt, trauma and may conclude with multiple organ dysfunction syndrome and death. While varying mechanisms of injury may lead to different presentations of shock and cardiovascular decompensation, a unifying theme of traumatic shock is an overwhelming inflammatory response driven by proinflammatory cytokines, and the downstream results of this cytokine storm including, but not limited to, acute respiratory distress syndrome, coagulopathy, sepsis, and multiple organ dysfunction syndrome. Treatment is primarily supportive; however, research into novel therapeutics for traumatic shock is ongoing and promises some direction for future care.

The management of patients with spinal cord injury.

Few diseases or injuries have greater potential for causing death or having a devastating impact on a person's quality of life than cervical spine trauma. All patients admitted to hospital after significant trauma must therefore be assumed to have a potentially unstable spinal fracture until it is proven otherwise, to prevent their sustaining further injury owing to inappropriate management. It is vital that nurses are familiar with the signs and symptoms of such injuries and aware of the appropriate management techniques.

Cardiovascular considerations in the critical care phase.

Spinal shock results in impaired cardiovascular reflexes of those persons with spinal cord injury above T6. This population can be at high risk for cardiovascular instability. Sympathetic pathways are interrupted and the result is uninhibited vagal tone and vascular atony. The spinal shock victim presents with hypotension, hypothermia, and bradycardia. Hypovolemia, hypoxia, and further temperature decreases can precipitate instability. Overhydration can lead to pulmonary edema and extended injury. The goal of therapy is to optimize perfusion with positioning, careful fluid replacement, and pharmacologic agents as needed. Cardiac rhythm disturbances are common and can be potentiated by hypoxia, endotracheal suctioning, hypothermia, and position changes. The goal of treatment is to avoid the offending event and to pretreat anticipated bradydysrhythmias with atropine. Close monitoring of cardiac and respiratory status is a minimum requirement for such patients. Within the high risk group exists a subgroup who demonstrate a high degree of cardiovascular instability. This group has a high mortality rate. Identification of patients who may require prolonged monitoring or more aggressive therapies may assist in eventual positive outcomes.