Patient selection: Orthopedic approach in polytrauma

Abstract

The development of the two hit theory has been helpful in understanding why certain patients may deteriorate unexpectedly after a major trauma and subsequent major surgery [1, 2]. Both the type and the severity of injury, the rescue conditions, and the individual patient's response are given facts at the time of patient's admission, representing the first hit in a trauma patient [1]. The subsequent treatment and unexpected complications can modify the clinical course substantially [3-7]. Thus, during the hospital stay, volume replacement, ventilatory support, and the surgical strategy are important variables [8] that may be modified by the hospital physician and thus regulate the degree of the impact of the second hit [9]. © 2010 Springer-Verlag New York.