Ch 24: Trauma, Surgery, and Burns Flashcards
What are fluid resuscitation requirements in early burn patients?
Use Parkland formula; 4 mL of lactated Ringers for each kg of body weight multiplied by the TBSA. One half of this total amount is administered in the first 8 hours after the burn. The remaining is administered over the subsequent 16 hours, followed by maintenance fluids.
Inhalational injury results in additional fluid needs and is often estimated as another 10% of TBSA
For those with burns > 20% TBSA, which supplements are recommended?
Daily supplements including an MVI, 20,000 IU vit A, and 200 mg zinc plus twice daily doses of 500 mg ascorbic acid are recommended. Supplemental doses of selenium and copper and vit D may be considered if levels are low
In patients with large surface area burns, how much protein may be requierd?
Higher protein loads (3-4 g/kg/d) may be required
PN for fewer than ___ days has not shown a benefit
5 days
What are the nutritional components to ERAS?
The first is to avoid preop fasting, and solid meals are provided up to 6 hours before surgery. In additional, 800 mL of a CHO rich clear liquid is given at MN and 400 mL of the same formula is given 2 hours before surgical intervention.
Why is body weight measured in ICU not a valid indicator of body cell mass?
Due to resuscitation of fluids, capillary permeability, edema, anasarca which translate into elevated body weights
All trauma/burn patients undergo a systemic inflammatory response syndrome (SIRS), which entail presence of 2 out of 4 abnormal systems. What are these systems?
Heart rate, respiratory rate, temperature, and white blood cell count
Effective treatment of SIRS focuses on what 3 strategies?
Oxygen delivery, source control, and nutrition support
Nighttime cycling of EN may be considered when patients are meeting what percentage of energy goal by oral route prior to d/c’ing EN?
60%
True of false: Bowel sounds are required to start EN
False; neither the presence nor absence of bowel sounds nor evidence of passing flatus or stools is required prior to initiation of EN
What are the MVI/mineral requirements for a critically ill patient?
Current recommendations for critically ill patients are to provide at minimum DRI for vitamins/mineral
How soon can PEG be used after placement?
In adults, current practice recommendations indicated that after a PEG is placed, it may be used for feeding within 2 hours instead of the routine 24-hour delay
When patients are unable to consume at least ____ of nutrition needs orally, EN or PN should be considered
60%
In the metabolically stressed adult, the max rate of glucose oxidation is what?
4-7 mg/kg/minute
What are the objectives of ERAS?
Objectives are to avoid starvation, decrease physiological stress of surgery (induces insulin resistance), limit post op IV fluids, optimize pain control, GI function, and mobilization
