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Flashcards in Nutritional support in Trauma Deck (51):
1

define trauma

An injury or wound to living tissue caused by extrinsic agents

2

immediate features of trauma

intravascular fluid loss
extravascular volume
tissue destruction
obstructed or impaired breathing.

3

later features of trauma

starvation, infection and inflammation

4

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

5

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.

6

what are the 3 phases after suffering from trauma

phase 1- clinical shock
phase 2-hypercatabolic state
phase 3- recovery (anabolic)

7

through what 2 mechanisms can phases 1 and 2 of suffering from trauma occurs

spontaneous-physiological adaptation.
Resuscitation- intervention.

8

within how many hours does phase 1 (shock), develop and how long does it last for

2-6 hrs
lasts 24-48 hrs

9

what 2 chemicals are secreted in shock (3 C's)

cytokines,catechoalmines, cotrisol

10

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.

11

what are the 2 main aims in phase 1

stop bleeding and prevent infections

12

when does phase 2 (catabolic phase develop)

2 days post trauma

13

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

14

what are the main aims in phase 2

avoid sepsis, provide adequate nutrition

15

when does phase 3 (anabolic phase) develop

3-8 days after uncomplicated surgery.
or weeks after trauma and sepsis.

16

what happens during phase 3

gradual restoration
normal nitrogen balance
body synthesis protein
fat stores and muscle strength

17

what are the primary aims of phase 3

Adequate nutrition supply

18

what syndrome much be avoided in phase 3- occurs due to increasing nutrition levels to fast after trauma

re feeding syndrome

19

what are the stages in the inflammatory response at the site of trauma

1. Bacteria and pathogens enter the wound
2. Platelets release clotting factors.
3. Mast cells secrete factors that mediate vasodilation to increase blood delivery to the injured area.
4. Neutrophils+ macrophages recruited to phagocytize pathogens.
5. Macrophages secrete cytokines to attract immune cells + proliferate the inflammatory response
6. Inflammatory response continues until wound is healed.

20

define systemic capillary leak

Everything leaves the capillary into extracellular space (H20, NaCl, Albumin, energy substrates.)
This results in blood pressure decreasing

21

what causes systemic capillary leak

inflammatory mediators realised due to injury

22

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

23

what are the 5 cardinal signs

heat, redness, swelling, pain and loss of function

24

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.

25

what substance does the brain use upon glucose depletion

ketones

26

what substance does the body use upon glucose depletion (except brain)

glycogen.

27

what organs are capable of gluoconeogensis

kidney and liver

28

where does glycogenolysis occu

skeletal muscle

29

how much protein does 1kg of muscle make

200g

30

how much glucose does 1kg of muscle make

120g

31

what is the metabolic response to trauma when glucose is low

glycogenolyis
gluconeogenesis
lipolysis+ ketogenesis.

32

what is the end product of lypolysis

acetoacetate & hydroxybutyrate

33

how does the body adapt to hypoxia.

anaerobic metabolism

34

how many ATP's are produced per glucose in anaerobic and aerobic reparation

36 ATPs
2 ATP's

35

what are 2 of the main problems which arise from anaerobic respiration

lactic acid production
inadequate energy production (2ATP per glucose)
leads to cell death.

36

what must the pH be to be classed as lactic acidosis

pH

37

what happens to protein production during trauma

decreases
(in trauma skeletal muscle proteolysis)

Increase
incased inflammatory modulators and scavengers.

38

what happens if too much proteolysis occurs

life-threatening damage to essential structural and secreted protein.

Respiratory muscle weakness results in poor cough, retention of secretions and ultimately pneumonia

39

what molecule is often used as a prognostic marker in trauma

blood lactate

Failure of blood lactate to return to normal following trauma resuscitation carries a poor prognosis.

40

What factors much be considered when provided someone with nutritional support post trauma

hyper metabolic phase
pre-trauma nutritional state
nitrogen loss- long bone, serve burns
immobilisation increased loss-calcicum, phosphate, magnesium

41

what is primary malnutrition

protein calorie undernutririton
dietary deficiency of specific nutrients

42

what is secondary malnutrition

– Nutrients present in adequate amounts but appetite is suppressed
– Nutrients present in adequate amounts but absorption and utilization are inadequate
– Increased demand for specific nutrients to meet physiological needs

43

consequences of malnutrition

negative nitrogen balacne
muscle wasting
widespread cellular dysfunction

44

CF affects secretory and epithelial cells within which parts of the body.

airways, pancreas, liver, intestine, sweat glands and vas deferens

45

how does CF lead to malnutrition (pancreas)

the mucus productions become thick, pancreas gets blocked and cannot release digestive enzymes which are needed to breakdown macromolecules.

46

how CF cause lung problems

increased bacterial colonisation
neutrophils accumulate
elastase is secreted which digests lung proteins causing tissue damage
dead neutrophils release DNA which increases the viscosity of CF sputum.

47

what is a common sign at birth which suggests CF

meconium ileus

48

what other signs do pancreatic cysts in CF present with

low insulin- diabetes
low lipase- lipid malnutrition (steatorrhea)
low proteases
poor appetite

49

treatment of CF (lung symptoms)

physiotherapy, exercise, bronchodilators, antibiotics, nebuliser, steroids, mucolytics, infection and inflammation

50

treatment for CF (GI symptoms)

Pancreatic enzyme replacement (Creon)
Nutritional supplements
Fat-soluble vitamins
High calorie diet

51

refeeding syndrome

starvation- body tries to conserve the limited amounts of glucose and protein and starts using ketones. Minerals also become depleted- insulin secretion is low

when feed- insulin secretion increases so the body is told to form glycogen, proteins etc and this requires phosphates, magnesium and potassium which are already depleted and the stores rapidly become used up.