Trauma flow phase

Table 18.1 Biochemical and physiological changes during the ebb and flow phases of trauma...

In the ebb phase, there is increased activity of the sympathetic nervous system and increased plasma levels of adrenaline and glucocorticoids but a decreased level of insulin. This results in mobilisation of glycogen in the liver and triacylglycerol in adipose tissue, so that the levels of two major fuels in the blood, glucose and long-chain fatty acids, are increased. This is, effectively, the stress response to trauma. These changes continue and are extended into the flow phase as the immune cells are activated and secrete the proinflammatory cytokines that further stimulate the mobilisation of fuel stores (Table 18.2). Thus the sequence is trauma increased endocrine hormone levels increased immune response increased levels of cytokines metabolic responses. 

During the flow phase there is a marked increase in energy expenditure and oxygen consumption. To satisfy this, the cardiac output is increased, from a resting value of about 5 litres per minute, by two fold during mild trauma, or as much as threefold in severe trauma or sepsis. Resistance to blood flow in peripheral arteries decreases, which can lead to... 

The response to trauma can be divided into two phases the ebb and the flow. The ebb phase lasts for about 12 to 24 hours after the insult, after which there is a smooth... 

A thorough history and physical examination are prerequisites to diagnostic accuracy. The fundamental aim of the initial phase of assessment is to distinguish arterial from ischemic priapism. The sexual and medical history should especially focus on medications, trauma and predisposing comorbidities. Presence or absence of pain is a fairly reliable predictor oflow-flow versus high-flow priapism, respectively. Absence of pain in arterial priapism frequently results in less patient anxiety and discomfort as compared with veno-occlusive priapism. Consequently, patients with arterial priapism may present days or even weeks after the original injury (Ricciardi et al. 1993). 

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