Critical Care Part 1 Flashcards by Sydney Perry

Who goes to the ICU?

respiratory failure
shock, major trauma
MI, CVA, DKA
SIRS/Sepsis
major burns
acute liver failure
transplants
major surgeries

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transplants that go to ICU

♡
lung
liver
small bowel

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major surgeries that go to ICU

CABG
AAA repair
thoracic surgery
major abdominal surgery

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METABOLIC STRESS RESPONSE

The _______, ______ response to acute injury or disease

Can be caused by=> ____, _____, ____, ____, ____

Magnitude of the response correlates with ______

Metabolic alterations begin at the time of injury and persist until healing is complete

hypermetabolic, catabolic

trauma, infection, sepsis, burns, surgery

severity of injury

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3 phases of Metabolic stress response

Ebb Phase
Flow phase
adaptive response

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Ebb Phase of metabolic stress response

when does this phase occur?

during this phase, you will have decreased ______, _______, _______, and ______

you will also have _______, ________, and _____

Also ______ insulin and ______ glucagon secretion

2-48 hours after injury

BP, cardiac output, metabolic rate, O2 concumption

hypovolemia, tissue hypoxia, shock

decreased
increased

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FLOW PHASE OF METABOLIC STRESS RESPONSE
when does it begin?
how long does it last?

You will get increased/decreased ________, ________, ________, and ______

increased release of ________

increased release of pro wound healing substrates such as ______, ______, _____

once hemodynamically stable
several weeks or longer

increases cardiac output, O2 consumption, metabolic rate, and protein catabolism

cytokines

catecholamines, glucagon, cortisol

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FLOW PHASE OF METABOLIC STRESS RESPONSE

______ synthesis of positive acute-phase proteins. These protein are for ______, ______, and ______. Examples include _____, _____, ______, and ______

_______ synthesis for negative acute-phase proteins. Examples include _____, ______, _____

increased
inflammation, wound healing, coagulation
c-reactive protein, ceruloplasmin, fibronectin, ferritin

decreased
albumin, prealbumin, transferrin

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ADAPTIVE RESPONSE PHASE

Hormonal response _____
Metabolic rate _______

________ predominates but can only occur in the presence of ______

gradually diminishes
normalizes

Anabolism
adequate nutrition

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HORMONAL RESPONSE
Tissue injury causes increased levels of __________ hormones such as _____, ____, _____, ____, ____

counterregulatory

glucagon
cortisol
catecholamines
Aldosterone
ADH

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Glucagon=> (2)

hepatic glycogenolysis

gluconeogenesis

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Cortisol=> (3)

skeletal muscle catabolism to provide aa for hepatic gluconeogenesis & positive acute phase protein synthesis

glycogenolysis

increased lipolysis

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Catecholamines=> (5)

glycogenolysis
gluconeogenesis
lipolysis
decrease insulin release
cause temporary insulin resistance

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Aldosterone=> (1)

increases Na reabsorption by the kidneys

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ADH=> (1)

increases water reabsorption by the kidneys

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cell mediated response involves the release of ______

cytokines

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examples of cytokines

interleukin-1
interleukin-6
tumor necrosis factor (TNF)

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When cell mediated response releases cytokines which are ______ proteins.

Released by _____, ____, and _____ in response to tissue damage, infection, or inflammation.

stimulates ______, _______, ________, and ____

pro-inflammatory

macrophages, T helper, mast cells

muscle catabolism
gluconeogenesis
hepatic aa uptake & positive acute phase protein synthesis
anorexia

what does IL-1 do

decrease serum zinc and iron

METABOLIC STRESS RESPONSE
CHO Metabolism

________ are depleted quickly

________ glucose production and ________ temporary inhibition of _____ release leads to ______

Glycogen stores

Increased
epinephrine’s
insulin
hyperglycemia (“stress diabetes”)

METABOLIC STRESS RESPONSE
PRO METABOLISM
__________ leads to ____________

LBM catabolism
negative nitrogen balance

How LBM catabolism happens
- _____ are oxidized as a source of energy for muscles.
- Provides aa for _______ synthesis

BCAA
acute phase protein

Rapid loss of LBM occurs due to the effect of ____________, imbalance between ___________, and ___________

catabolic hormones and cytokines

energy intake and energy needs

physical immobilization

METABOLIC STRESS RESPONSE
LIPID METABOLISM

________ lipolysis of TG stores due to __________

________ circulation of FFA to be oxidized for energy

_______ ketosis than seen in starvation

Increased
increased levels of counterregulatory hormones

Increased

Less

NET EFFECT OF HORMONAL AND CELL MEDIATED RESPONSE ________ state ________ availability of substrates for metabolically active tissues but ________ ______ nitrogen balance Increased _____, ____, and _____

Hypercatabolic Greater poor utilization Negative blood volume, BP, & edema

Metabolic Response to Stress vs. Starvation In Starvation... REE _________ counter-regulatory hormones ________ _____ ketosis _______ gluconeogenisis

decreases do NOT increase more decreased (protein spared and fat used)

burn consequences include _____, loss of __________, _______ and _______/_______ with large _______

pain water and nutrients infections hypermetabolism/catabolism protein

HYDRATION FOR BURNS During 1st 24-48 hours ____________ volume of fluid needed is based on ____, _____, and ________ after resuscitation consider ______ plus _______

fluid & electrolyte replacement age, wt, & total body surface area (TBSA) burned maintenance plus losses

For Hydration, monitor... _____ ________ _______ ________ _________

weight physical signs serum Na serum osmolality I&O records

ENERGY NEEDS FOR BURNS often _____ needs of other injuries needs increase with _______ REE can almost ______ for severely burned patients _______ may not be feasible

exceeds size of burn double weight gain

Best to determine energy needs with _________ conducted ______ common equation for burns is ______ with SF _____

indirect calorimetry weekly Harris-Benedict Equation (HBE) 1.5

PROTEIN NEEDS FOR BURNS Elevated due to _________, wound healing, losses via wounds & urine 1.5-2.0 g/kg Provide: _______% kcal from protein May consider use of supplemental ______

gluconeogenesis 1.5-2.0 g/kg 20-25% arginine

Most patients with <___% TBSA burned can meet their needs with an oral diet: - High kcal & protein diet with oral nutrition supplements Those with a poor appetite, orally intubated on a vent, or >___% TBSA burned may require tube feeding - High protein, high kcal formula

20 20

MICRONUTRIENTS FOR BURNS ________ needs Rx __________, __________, ___________, and monitor electrolytes

increased MVI with minerals Vitamin C: 500 – 1000 mg/d Zinc: 220 mg ZnSO4 (50 mg of elemental zinc)

Systemic Inflammatory Response Syndrome (SIRS) Widespread inflammation resulting from=> (6)

infection severe acute pancreatitis ischemia burns major trauma hemorrhagic shock

SIRS results in the release of _________, __________, and _________ ______ and ________ can occur also can lead to _____ damage and _____

cytokines (increase capillary permeability) proteolytic enzymes toxic oxygen species hypotension & hypoperfusion organ damage and MODS

Hypotheses for the Development of SIRS

Excessive production of proinflammatory cytokines Disruption of gut barrier function leading to bacterial translocation

Multiple Organ Dysfunction Syndrome (MODS) stages?

primary secondary faillure

primary MODS

caused by direct organ injury

secondary MODS

SIRS or sepsis

MODS failure

lungs kidney liver intestines

MNT for SIRS & MODS Increased ____ and ____ to meet increased metabolic demands - However, avoid ______ - Use _________ Early _____ (unless hemodynamically unstable) If prolonged small bowel ileus=>_____

kcal & protein overfeeding indirect calorimetry EN PN