Basics of PRS Flashcards
Recommended protein intake for severely burn patients by TBSA?
TBSA 15-30: 1.5 g/kg/day
TBSA 30-50: 1.5-2 g/kg/day
TBSA >50: 2-2.5 g/kg/day
Recommended carbohydrate intake per day (adults, kids, infants)?
Adults: 5 mg/kg/day
Kids: 8 mg/kg/day
Infants: 15 mg/kg/day
What are the benefits of early enteral feeding in burns?
Reduced hypermetabolic response Reduced catabolic hormones (TNF, IL1, IL6) Improved N-balance Gut mucosal integrity Less diarrhea Decreased LOS
Vitamins and supplementation in burns?
Vitamin A, D, C Zinc 200mg daily glutamine, arginine Ornithine-alpha-keto-glutarate Omega 3 fatty acis oxandrolone Propanolol Insulin
Which mediators drive hypermetabolism in burns?
TNF, IL1, IL6
Give 4 consequences of burn hypermetabolism?
Insulin resistance
Muscle catabolism
Immune suppression
Negative nitrogen balance
What are ways to reduce hypermetabolism?
Control pain Warm environment Early debridement and wound closure Prevent infection/sepsis Oxandrolone
What are the different types of nerve fibers?
Type A (myelinated):
- Alpha: large motor
- Beta: small motor, pressure
- Gamma: proprioception, muscle tone
- Theta: temperature, pain, touch
Type B (myelinated): preganglionic autonomic
Type C (unmyelinated): dull pain, temperature, touch
What is the order of onset of different nerve fibers?
Onset: smaller to larger
B: vasodilation
C+A-theta: loss of pain, temperature, touch
A-gamma: proprioception, muscle tone
A-beta: small motor, loss of pressure sensation
A-alpha: loss of motor function
What are the stages of bone graft incorporation?
Hematoma Inflammation Vascular ingrowth Bone resorption New bone formation
Definition of mechanical creep?
Tissue recruitment on acute stretch: collagen orients parallel to vector, elastic fibers fragment, water displaced from ground substance
Definition of biologic creep?
Generation of new tissue due to chronic stretching force
Definition of stretch relaxation?
Force required to maintain tissue elongation decreases over time
What are the layers of the expander capsule?
Inner: synovial like lining
Central: elongated fibroblasts and myofibroblasts
Transitional: loose collagen
Outer: vasculature
What is the proposed mechanism for VAC?
1) Fluid based mechanism: removal of excessive fluid that compromises circulation, O2 delivery, transport of nutrient and waste
2) Mechanism: macrostrain (draws wound edges closer) and microstrain (deformation forces on cells stimulate angiogenesis and tissue growth)
