Trauma and Nutrition Flashcards
(47 cards)
What is the definition of trauma?
an injury or wound to living tissue caused by an extrinsic agent
What are the immediate features of physical trauma?
intravascular fluid loss
extravascular volume
tissue destruction
obstructed/impaired breathing
What are the more delayed features of physical trauma?
Starvation
Infection
Inflammation
What are the 4 most common causes of mortality from major trauma?
Haematological shock
head injury
acute respiratory distress syndrome
multi organ failure
What is interrupted in shock?
supply of substrates into the cell e.g. oxygen, glucose, water etc.
removal of metabolites from the cell e.g. CO2, water, free radicals etc.
What are the 3 phases of mortality from trauma?
Phase 1: clinical shoke
Phase 2: Hypercatabolic state
Phase 3: recovery (anabolic state)
How do you get from phase 1 to phase 2 in mortality from trauma?
spontaneous recovery - physiological adaptation
resuscitation - intervention
What is the duration of phase 1 (shock)?
develops 2-6 hours after injury
lasts 24-48 hours
What is secreted in phase 1 (shock)?
cytokines
catecholamines
cortisol
What are body’s responses in phase 1 (shock)?
tachycardia - increased heart rate increased respiratory rate peripheral vaso-constriction - shut down of vital organs to preserve them hypovolaemia
What are the primary aims in phase 1 (shock)?
stop bleeding
prevent infection
What is the duration of phase 2 (catabolic state)?
2 days after injury
What is secreted in phase 2 (catabolic state)?
Catecholamines
Glucagon
ACTH → Cortisol
What are the primary aims in phase 2 (catabolic state)?
Avoid sepsis
Provide adequate nutrition
What are body’s responses in phase 2 (catabolic state)?
↑ Oxygen consumption ↑ metabolic rate ↑ Negative nitrogen balance ↑ Glycolysis ↑ Lipolysis
What causes negative nitrogen balance?
skeletal muscle breakdown to release amino acids
What is the duration of phase 3 (anabolic state)?
3-8 days after uncomplicated surgery
can be weeks after severe trauma/sepsis
What are body’s responses in phase 3 (anabolic state)?
Gradual restoration of:
body protein synthesis, Normal nitrogen balance, Fat stores, Muscle strength
What are the primary aims in phase 3 (anabolic state)?
Adequate nutrition supply is critical in this phase - beware of risk of Refeeding syndrome risk
What is ‘obesity paradox’?
the fact that after trauma, obese people do better in recovery
What are the 5 steps in the inflammatory response at a trauma site?
- Bacteria and pathogens enter wound
- Platelets release clotting factors
- Mast cells secrete factors that mediate vasodilation - ↑ blood delivery to the injured area
- Neutrophils + macrophages recruited to phagocytose pathogens
- Macrophages secrete cytokines - attract immune cells + proliferate the inflammatory response
What effect does inflammatory mediator release have on the capillaries?
systemic capillary leak - leaks H20, NaCl, albumin and energy substrates
What effect does cytokines IL-1, IL-6 and TNF have on the body?
local effects e.g. vasodilatation catabolic effects B/T cell proliferation anorexia endocrine effects fever fibroblast proliferation repair
What are the 5 cardinal signs of inflammation?
heat redness swelling pain loss of function
