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Chapter III

Battle Casualties in Korea, Studies of the Surgical Research Team, Volume I

The Systemic Response to Injury-Perspective

Lieutenant Colonel Carl W. Hughes, MC, USA

Trauma initiates a dynamic process. The wound is more than a wound of the moment and the patient responds in toto to this continuing stress. Every system of the injured man participates in the reaction to blood loss, tissue destruction, and bacterial infection.

The systemic changes are complex and influenced variably by the site and extent of the injury, environmental conditions, the age of the patient, and the type of treatment. Loss of blood and the possible absorption of toxins induce local and systemic responses. Reflexes, vascular and hormonal changes, and anoxia may further modify the pattern of the patient's fight for survival. Like the response of local wound healing, this response of every part of the body is a continuing process of days or weeks.

In order to record some of these systemic responses to injury, the reports of the Surgical Research Team of Korea have been compiled into four bound volumes of related papers. The volumes were not intended to, and do not, serve as a comprehensive review of the physiology of trauma. They do record data obtained in the field under difficult combat conditions and reflect the cooperation of many divisions, installations, and personnel of the Medical Service.

The first two volumes are concerned primarily with the study of the systemic response to injury. Since the circulatory system plays a major role in the body's reaction to trauma, much of the emphasis is placed on the cardiovascular and hematologic systems. The cardiovascular system responds first to injury by vasoconstriction and changes in cardiac rate and output. Related observations on the hypertensive response to injury, the autonomic nervous system responses, the hematologic responses, the role of vasoconstrictors have been recorded in these first two volumes. Other related studies included are the coagulation response, the use of plasma expanders, and the effects of injury on gallbladder function.

The liver plays a major role in the body's response to trauma as evidenced by changes in metabolism and excretion of carbohydrates, proteins, bile pigments and other substances. Hepatic function in the wounded man shows a depression as measured by a significant rise in the van den Bergh index and BSP retention. It is often difficult to differentiate between depression of function and deviation of function to spheres more vital to survival and recovery of the individual. For


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example, does the BSP retention indicate hepatic damage or deviation of the hepatic function to energy production?

The third volume contains studies related more directly to the battle wound. Topics included relate to studies of wound infection, the bacterial flora of the wound, wound healing, and blood vessel surgery. Careful observations on resuscitation, massive transfusion, and the use of antibiotics, all of which are extremely important in the understanding of man's over-all response to trauma, are included in Volume III.

The establishment of a renal insufficiency treatment center in Korea permitted a great deal of valuable information to be collected, portions of which are included in Volume IV. Here are recorded the surgical and medical management of the renal insufficiency patient, including studies on local wound healing, bacterial contamination, and also observations on the relation between uremia and infection in those patients.

Other observations were made which defy strict separation into a specific category because the different elements of injury often involve many systemic reactions. For this reason, some reactions related to a specific element of injury which have been recorded in one volume also have a direct bearing on studies recorded in several volumes.

These studies carried out on the combat casualty have made possible numerous observations of responses of the organism to trauma. While most systemic responses are helpful and protective, it is possible that others, such as vasoconstriction and paralytic ileus, may ultimately prove to be harmful. These findings are included in the papers bound into these volumes in the hope that the studies will prove helpful and provocative to those who read them.