Pavel Isaías Miramontes López

Olytrauma is a major cause of mortality, disability, and prolonged critical illness worldwide, particularly among young and economically active populations. Beyond the initial anatomical injury, severe trauma triggers a complex systemic response involving inflammatory activation, endothelial dysfunction, metabolic and endocrine alterations, coagulation abnormalities, immune dysregulation, and progressive organ failure. The objective of this review was to analyze current evidence regarding the inflammatory, metabolic, and organ dysfunction pathways associated with polytrauma from a multidisciplinary perspective integrating traumatology, orthopedics, internal medicine, endocrinology, and critical care medicine. A narrative and integrative literature review was conducted using scientific databases including PubMed/MEDLINE, Scopus, ScienceDirect, PMC, and Google Scholar. Peer-reviewed articles, clinical reviews, trauma guidelines, and observational studies related to systemic trauma physiology, trauma-induced coagulopathy, metabolic dysfunction, and multiple organ dysfunction syndrome were analyzed. The reviewed evidence demonstrated that inflammatory mediators such as interleukin-6, tumor necrosis factor-alpha, complement activation products, and oxidative stress pathways play fundamental roles in systemic deterioration after severe trauma. Simultaneously, hypercatabolism, stress hyperglycemia, insulin resistance, and prolonged endocrine activation contribute significantly to physiologic instability and delayed recovery. Trauma-induced coagulopathy emerged as a dynamic process strongly associated with endothelial injury, inflammatory signaling, hemorrhagic shock, and microvascular dysfunction. Pulmonary, cardiovascular, renal, hepatic, and neurological dysfunction represented the most frequent systemic complications identified during trauma progression.

Acute abdomen remains one of the most challenging clinical conditions in emergency medicine and general surgery due to its heterogeneous etiologies, variable presentation, and high risk of rapid clinical deterioration. The objective of this review was to analyze acute abdomen as a multidisciplinary challenge through the integration of emergency medicine, radiological imaging, and clinical decision-making. A narrative review methodology based on scientific literature indexed in PubMed and Scopus was utilized, incorporating international guidelines, radiological recommendations, and evidence-based emergency surgery studies. The review evaluated major abdominal emergencies including appendicitis, intestinal obstruction, acute cholecystitis, pancreatitis, perforated viscus, mesenteric ischemia, and intra-abdominal infections. The findings demonstrated that early imaging integration, particularly computed tomography and ultrasonography, significantly improves diagnostic accuracy and therapeutic prioritization. Additionally, multidisciplinary collaboration between emergency physicians, radiologists, surgeons, intensivists, and anesthesiologists was identified as a key factor in reducing diagnostic delays and improving patient outcomes. The study also highlighted important healthcare system challenges affecting emergency abdominal care in Latin American countries such as Mexico, Colombia, and Ecuador, including limited imaging accessibility, emergency overcrowding, delayed specialist consultation, and interhospital transfer barriers. The evidence supports the implementation of structured multidisciplinary protocols and evidence-based diagnostic pathways to optimize emergency abdominal management. Acute abdomen should therefore be understood as a multidimensional emergency syndrome requiring coordinated interdisciplinary evaluation, rapid imaging utilization, and individualized therapeutic strategies to improve clinical outcomes and patient safety.

Modern surgical practice unfolds in environments characterized by uncertainty, time pressure, technological complexity, and high clinical stakes. Within these conditions, cognitive load emerges as a critical determinant of surgical judgment and intraoperative decision-making. This integrative review synthesizes interdisciplinary evidence from cognitive neuroscience, human factors engineering, and surgical education to examine how mental workload influences performance stability, error vulnerability, and adaptive reasoning during high-risk procedures. The reviewed literature consistently demonstrates that increased cognitive load is associated with performance degradation, particularly when stress amplifies attentional demands and working memory capacity is exceeded. Expertise moderates this relationship by promoting automaticity and efficient cognitive resource allocation; however, even experienced surgeons remain susceptible to overload under unstable or unfamiliar conditions. Measurement methodologies—including subjective workload scales, physiological indicators, behavioral proxies, and neurophysiological signals—reflect ongoing efforts to operationalize cognitive strain within clinical environments. Simulation-based training, deliberate practice frameworks, team communication protocols, and cognitive offloading strategies are repeatedly described as mechanisms capable of enhancing decision stability under pressure. The findings suggest that cognitive load should be conceptualized as a modifiable patient safety variable rather than an unavoidable byproduct of surgical complexity. Integrating cognitive science principles into surgical training and workflow design may strengthen adaptive decision-making and reduce preventable errors. These implications are particularly relevant for diverse international healthcare systems, including those with heterogeneous institutional resources, where optimizing cognitive performance can contribute meaningfully to operative reliability and patient safety.