: trauma is the leading cause of death age 1-38; #3 cause overall; MVA are the most common accidental deaths
50% of traumatic deaths are immediate
30% are early (due to hemorrhage, head injury, respiratory failure)
20% are late (80% of late trauma deaths are due to sepsis sepsis)
lower respiratory infection is the leading infection and cause of mortality
; also UTI and wound infection
Immunology
: both cellular and humoral immunity are diminished following trauma due to a variety of reasons
T, B, and NK cells are all depressed after trauma
leukocytosis and depressed skin-test anergy are also common
monocyte antigen presenting activity is diminished
this is compounded by disruption of skin and mucosal barriers, medications, nutritional deficiencies
Risk of Infection
infection: hypotensive shock on admission; blunt injury (always worse than penetrating trauma); injury severity score, Glasgow coma scale (head injury means more hospital time Þ more infection); extremity injury
pneumonia: head injury; shock, ISS; blunt injury; pulmonary contusion (blood in the lung)
Etiology
early (2-4 days): normal nasopharyngeal flora (pneumococcus, H. flu, S. aureus)
late: (< 4 days): hospital acquired organsisms (pseudomonas, klebsiella, E. Coli, enterococcus, S. aureus)
Other Pearls
multiple trauma has nothing to do with surgery
multisystem failure means death (mortality < 70%): failure of at least 3 systems, most commonly due to sepsis
closed head injuries are febrile illnesses: almost all cases of meningitis and brain abscess follow dural disruption
facial fractures are more easily diagnosed with the nose than the eyes: need nasal aspiration for diagnosis
pulmonary contusion turns the lung into a blood agar plate