Physiology

Question 1

Name 10 clinical manifestations of the physiological stress response

Answer 1

• Tachycardia, tachypnoea
• low grade fever
•Oliguria - water retention, weight gain
- vasodilation
• leukocytosis
. Hyperglycaemia
• increased CRP and procalcitonin
• decreased albumin
• loss muscle mass - weight loss
• poor appetite and erratic sleep pattern
. Cognitive impair

Question 2

Name 8 factors that worsen the physiological stress response post trauma

Answer 2

• shock and severe haemorrhage (acidosis, hypothermia, coagulopathy)
• inappropriate fluid management - excess use crystalloid and synthetic colloids increase. inflammation leading to multiple organ failure
•Massive transfusions
• major Surgery and multiple surgical interventions
• delayed, incorrect choice of surgery and complications
• sepsis and multiple organ failure
• uncontrolled comorbidities
Genetic factors- abnormal response

Question 3

Name 7 factors that reduce the duration and degree of the physiological stress response post trauma

Answer 3

• Adequate resuscitation measures with early and complete control of haemorrhage and fecal contamination - damage control
• proper anaesthesia and analgesia
• careful use of blood transfusions and point of care coagulation testing (teg, RoTEM ) to guide treatment of coagulopathy
• limited use of crystalloids and synthetic colloids
.Manage comorbidities and complications
• appropriate antibiotic use and aggressive drainage of septic foci and removal of necrotic tissue
• careful surgical technique - correct procedure, time sensitive

Question 4

Define SIRS

Answer 4

Systemic inflammatory response syndrome

Abnormal inflammation in response to injury and surgery

Question 5

Define the sirs criteria

Answer 5

2 or more in presence of known causative agent eg trauma, surgery, infection:
. Fever >38 or hypothermia <36
• tachycardia >90
• tachypnoea >20 or pc02 <32 mm Hg
• leukocytosis > 12 x10^9 /L or leukopenia < 4 x10^9 /L
Sirs not necessarily sepsis!

Question 6

Name 6 geriatric physiological changes that are important to consider in trauma

Answer 6

• Declining cellular and organ function
• worsening stress response and risk sepsis
. Decreased physiology reserves - hypoxia, hypothermia, hypovolaemia, fluid overload poorly tolerated
• comorbidities impacting mortality - renal dysfunction, cirrhosis, coagulopathy, COPD, ischaemic heart disease, diabetes
• effects chronic drug use - B blockers( heart rate wont increase in shock), anticoagulation (TBI worse), vasodilators, ace inhibitors (renal function), antidepressants, sedatives
• immobility - pressure ulcers, difficult rehab

Question 7

Name 4 hallmarks of the stress response to trauma and surgery

Answer 7

• Release and activation endogenous catecholamines, ACTH, cortisol, ACTH and other hormones
• inflammation activation
• pro-coagulation
• increased metabolism ( hypercatabolic) with negative nitrogen balance

Question 8

Most predominant cytokine for neutrophil activation in sirs?

Answer 8

Interleukin 8

Question 9

Which factor has chemoattractant and mitogenic properties for fibroblasts?

Answer 9

Platelet derived growth factor PDGF

Question 10

Which cytokine suppresses macrophage response to injurious Stimuli?

Answer 10

Interleukin 10

Question 11

Which chemical initiates platelet aggregation?

Answer 11

Thromboxane

Question 12

Which cytokine is the endogenous pyrogen produced in response to lipopolysaccharide?

Answer 12

Interleukin 1