Nutritional support in Trauma Flashcards
define trauma
An injury or wound to living tissue caused by extrinsic agents
immediate features of trauma
intravascular fluid loss
extravascular volume
tissue destruction
obstructed or impaired breathing.
later features of trauma
starvation, infection and inflammation
when is the highest risk of developing acute respiratory distress syndrome and multi organ failure after trauma
initial risk is low and then after a few days the risk increases and then it decreases
what functions are interrupted by shock
supply of substrates to the cell- oxygen, glucose, water, lipids, amino acids and micornutrients.
removal of metabolites from a cell- CO2, water, free radicals, toxic metabolites.
what are the 3 phases after suffering from trauma
phase 1- clinical shock
phase 2-hypercatabolic state
phase 3- recovery (anabolic)
through what 2 mechanisms can phases 1 and 2 of suffering from trauma occurs
spontaneous-physiological adaptation.
Resuscitation- intervention.
within how many hours does phase 1 (shock), develop and how long does it last for
2-6 hrs
lasts 24-48 hrs
what 2 chemicals are secreted in shock (3 C’s)
cytokines,catechoalmines, cotrisol
what are the main signs that a person is in phase 1 (shock)
increased heart rate, increased respiratory rate, peripheral vasoconstriction (selective peripheral shutdown to preserve vital organs), hypovolemia.
what are the 2 main aims in phase 1
stop bleeding and prevent infections
when does phase 2 (catabolic phase develop)
2 days post trauma
what molecules are secreted and what signs are present during phase 2
cathecholamines, glucagon, cortisol.
Increased oxygen consumption, increased metabolism, increased nitrogen balance, increased glycolysis, increased lipolysis
what are the main aims in phase 2
avoid sepsis, provide adequate nutrition
when does phase 3 (anabolic phase) develop
3-8 days after uncomplicated surgery.
or weeks after trauma and sepsis.
what happens during phase 3
gradual restoration
normal nitrogen balance
body synthesis protein
fat stores and muscle strength
what are the primary aims of phase 3
Adequate nutrition supply
what syndrome much be avoided in phase 3- occurs due to increasing nutrition levels to fast after trauma
re feeding syndrome
what are the stages in the inflammatory response at the site of trauma
- Bacteria and pathogens enter the wound
- Platelets release clotting factors.
- Mast cells secrete factors that mediate vasodilation to increase blood delivery to the injured area.
- Neutrophils+ macrophages recruited to phagocytize pathogens.
- Macrophages secrete cytokines to attract immune cells + proliferate the inflammatory response
- Inflammatory response continues until wound is healed.
define systemic capillary leak
Everything leaves the capillary into extracellular space (H20, NaCl, Albumin, energy substrates.)
This results in blood pressure decreasing
what causes systemic capillary leak
inflammatory mediators realised due to injury
What is the primary role of cytokines in an immune response
- Fibroblast proliferation (repair)
- Fever
- Endocrine effects- catabolic, anabolic.
- Anorexia
- T and b cell activation
- Acute phase proteins
- Metabolic effects (catabolic)
- Local effects- chemotaxis, vasodilation, cell adhesion proteins
what are the 5 cardinal signs
heat, redness, swelling, pain and loss of function
what are the endocrine effects of cytokines
secretion of catabolic hormones (e.g. IL1 and TNF-alpha)
• Increased ACTH (CORTISOL)
• Increased glucagon
• Catecholamine’s
secretion of catabolic hormones (e.g. IL1 and TNF-alpha)
Inhibition of anabolic hormones
– Decreased growth hormone
– Decreased insulin.
