-
What are the biochemical and physiological
pathways and characteristics of the initial hypovolemic ebb phase in the
response to trauma and metabolic stress? (5)
- (Everything is decreased)
- · Decreased cardiac output
- · Decreased O2 consumption
- · Decreased blood pressure
- · Decreased body temperature
- · Decreased insulin:glucagon ratio
-
What are the biochemical and physiological pathways and characteristics of the adaptive flow phase in the response to trauma and metabolic stress? (12) metabolism, losses, secretions, releases
- (Everything is increased)
- Increased energy expenditure
- Increased glucose production
- Increased net muscle catabolism
- Increased lipolysis; limited ketosis
- Hyperglycemia
- Increased BCAA (branched chain amino acid) oxidation
- Loss of LBM and negative N balance
- Increased ureagenesis and elevated BUN
- Increased urinary K+, P and Mg losses
- Secretion of antidiuretic hormone and aldosterone (Na and H20 retention)
- Secretion of ACTH, norepinephrine, epinephrine, glucagon and cortisol (increased metabolic rate, O2 consumption, body temperature)
- Release of cytokines and production of acute phase proteins
-
What are the characteristics of Multiple Organ Dysfunction Syndrome?
Complication of sepsis and SIRS (systematic inflammatory response syndrome); altered function in 2 or more organs; (typically lungs are first to be affected, so pt is on ventilator; kidneys are also quickly affected-dialysis; if gets to heart, outcome is not good)
-
What are possible (hypothesized) causes of Multiple Organ Dysfunction Syndrome? (3)
- Macrophage hypothesis: due to prolonged SIRS caused by continual macrophage stimulation (macrophage themselves cause the failure)
- Microcirculatory hypothesis: caused by tissue and
- cellular oxygen deprivation
- Gut hypothesis –gut bacteria are translocated to systemic circulation and sustain SIRS state; (GI tract cells become permeable, and get translocated to systemic circulation
- where it shouldn’t be)
-
Why should overfeeding be avoided in critically ill patients? (4)
- § Increases infection –hyperglycemia provides glucose (substrate) for bacteria to grow
- § Increases O2 consumption and CO2 production
- § Stresses heart and lungs
- § Impairs glycemic control
-
What
are the impacts of prolonged immobility on patients? (2)
- • Calcium and nitrogen losses & further break down of muscle tissue
- • Kidney stone and pressure sore formation
-
What are the calorie and protein needs of critically ill trauma and burn patients?
- • Energy Needs
- · Perform indirect calorimetry
- · General guideline: start with 1.5 as an injury factor and monitor response
- · Multiple trauma, burns and sepsis may greatly
- increase calorie needs
- · Obese patients: permissive underfeeding
- • Protein Requirements
- o 1.5-2.0 g/kg/d (in burn or closed head injury)
-
GI response to stress (4)
- Reduced blood flow to GI tract
- Increased ulcer formation
- Reduced motility-develop ileus
- Reduced intestinal absorptive surface area and immune function
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