Factors involved in the etiology of post-traumaticorgan failure. Shows the complex of factors, mediators and effectors involved in the development of organ failure. The endogenic factors (genetic predisposition and physical condition) form the basis for the susceptibility of a patient to post-traumatic organ failure. The sustained injury is seen as the first hit on the immune response and the "burden of surgery" is seen as the second hit, which can excacerbate the inflammatory reaction. The mediators stimulate the effectors which cause end-organ damage.