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

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

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

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

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

Hypothalamic –Pituitary adrenal (HPA) system

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 ✓

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.

Pituitary gland hormones? Origin Level ACTH Ant Pituitary  GH ~~ Prolactin TSH, LH  Vasopressin Post pituitary

Adrenal gland hormones? Origin Level Cortisol Cortex  Aldosterone ~~ Epinephrine Medulla Norepinephrine

Other hormones Hormones Origin Level Insulin Pancreas  Glucagon  Thyroxin Thyroid

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

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

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

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 ✓ ✗ ✗ ✗ ✓ ✗

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

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

SIRS vs. CARS

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

Immunological Response

Any Question

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

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