Hemodynamics should be carefully monitored, as trauma may cause large-scale fluid shifts and impair the body's ability to respond to stress. For example, patients with spinal cord injury may present in shock or respond poorly to blood loss, and those with chest trauma may have impaired cardiac and lung function. Burn patients require enormous amounts of fluid administration immediately after a burn, which must be monitored and tapered judiciously. Hemodynamic changes can also accompany traumatic limb amputation and head trauma. Hypotension in response to opioid administration may indicate hypovolemia and necessitate further aggressive fluid resuscitation. Sedation and respiratory depression as a consequence of overly aggressive opioid administration must be avoided, as this may interfere with the primary, secondary, and tertiary trauma surveys, as well as recognition of life-threatening conditions such as an occult intracranial hemorrhage (Hedderich and Ness 1998).

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