Support in Trauma

Question 1

define trauma

Answer 1

injury or wound to lining tissue caused by an extrinsic agent

Question 2

what are the immediate vs potential later features of physical trauma

Answer 2

i - intravascular fluid loss, extravascular volume, impaired breathing
l - starvation, infection, inflammation

Question 3

what are the three phases of mortality from trauma

Answer 3

1 - shock - 2-6hours, secret catecholamines, cytokines and cortisol - tachycardia, hypovol, peripheral vasoconstriction

2 - catabolic - 2 days after - catecholamines, glucagon, ACTH = cortisol
increased metabolic rate, o2 consumption, glycolysis, lipolysis

3 - anabolic state 3-8days after - restoration of body

Question 4

what are the primary aims of treatment of each phase of mortality form trauma

Answer 4

1 - stop bleeding prevent infection

2 - avoid sepsis provide adequate nutrition

3 - adequate nutrition (risk of refeeding syndrome)

Question 5

describe the inflammatory response at a trauma site

Answer 5

bacteria and pathogen enter would
platelet release clotting factors
mast cells secrete factors for vasodilation
neutrophils/macrohages = pagocytosis
macrophages - release cytokines = attract immune cells and inflammatory response

Question 6

what is systemic capillary leak

Answer 6

injury = inflammatory mediator risk - lose water, sodium, cl, albumin and energy substrates

Question 7

what are the 5 cardinal signs of inflammation

Answer 7

heat
redness
swelling
pain
loss of function

Question 8

what are the endocrine effects of cytokines

Answer 8

mediate secretion of catabolic hormones eg IL-1/TNF-a and ACTH = cortisol
this increases energy release

mediate inhibition of anabolic hormones eg dec growth and insulin

Question 9

what is the delivery of energy to the brain

Answer 9

can’t store glycogen so uses glucose
need constant glucose and o2
120g/day - will not survive longer than 2 hours without (can use ketones)

Question 10

how are the kidneys and liver different in survival for energy from the brain

Answer 10

liver/kidney can gluconeogenesis = survive hours without blood supply

Question 11

what are the phases of metabolic repose to trauma

Answer 11

1 - glycogenolysis - glycogen to glucose
2 - gluconeogenesis - amino acid -> glucose and lactate production
3 - lipolysis and ketogenesis - free fatty acid - acetyl CoA = acetoacetate and hydroxybutyrate (ketone bodies)

Question 12

what is the effect on ketones of water and electrolytes

Answer 12

diuretic so loss of both

Question 13

describe trauma protein turnover

Answer 13

new protein reduces

skeletal muscle proteolysis increases = increased FFA, ammonia and nitrogen loss

Question 14

what is a danger with increased trauma protein turnover

Answer 14

damage to respiratory muscles = retentions of secretions = pneumonia risk

Question 15

describe lactate production in hypoxia

Answer 15

reduced o2

pyruvate reduced to lactate - becomes toxic = tissue hypoxia

Question 16

describe how lactate is a prognostic marker for trauma

Answer 16

failure of blood lactate to return to normal - poor prognosis
if blood lactate is higher or equal to 5mmol/L = 100% mortality

Question 17

what is the deathly cycle of high lactate

Answer 17

mito failure from hypoxia = amnerobic glycolysis positive feedback

Question 18

what is the difference between primary and secondary malnutrition

Answer 18

1 - protein calorie undernutrition (starvation)
dietary deficiency

2 - appetite suppressed, absorption and utilisation inadequate
increased demand

Question 19

what are the consequences of malnutrition

Answer 19

negative nitrogen balance - muscle wasting - cellular dysfunction

Question 20

describe refeeding syndrome

Answer 20

excessive feeding after malnourishment
shift from fat to crab metabolism - insulin secretion and hypophosphateamia, reduced electrolytes
fatigue confusion inability toi breathe, coma and death

Question 21

describe the mutation mechanism of CF

Answer 21

CFTR transmembrane cAMP Cl dependant channel mutation

stops secretion of and absorptive of epithelial cells - airways, pancreas, liver vas deferens

Question 22

what are the consequences of CF

Answer 22

lack free flowing mucus - malnutrition as no digestive enzymes, lung diseases and infection = inflammation

Question 23

how does CF affect the GIT

Answer 23

meconium - intestinal failure
hepatobiliary disease
pancreatic cyst and exocrine insufficiency (low insulin/lipase/proteases)
poor appetite low weight

Question 24

what is the treatment of CF

Answer 24

respiratory disease - physio exercise, steroids, antibiotics and mucolytics - deceased infection and inflammation

GI - creon (pancreatic enzyme replacement), nutritional supplements
maintain body weight and avoid catabolism