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Response to Injury
Pathophysiology 4th year
Response to injury
Injury:
Surgical and Traumatic
Thermal and Electrical (Burns)
Infectious ( septicemia)
The Physiological Stress Response,
Metabolic
The immune response
Endocrine response
The Aim:
Identify and quantify the injurious agent
Maintain critical organ function
Restore homeostasis
Mobilize energy reserves
Provide substrate for tissue repair
Repair of dysfunctional tissue
Eradicate sepsis
Metabolic Response to Trauma: Ebb Phase
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Characterized by hypoperfusion
Priority is to maintain life/homeostasis
Metabolic Response to Trauma: Flow Phase
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 Catecholamines
 Glucocorticoids
 Glucagon
Release of cytokines, lipid mediators
Acute phase protein production
Consequences of energy needs are related to
Rate of weight loss
Composition of weight loss
Critical Loss of Lean Body Mass
Irreversible at some point
Nutrition
Causes of Muscle Proteolysis with Metabolic Stress
Increased demand for glucose
Increased rate of gluconeogenesis
ergy intake
Protein Requirements are Altered to Accommodate:
Immune response
Increased metabolic activity
Replacement of damaged cells
Replacement of protein losses
Nutrition
Factors influencing the Extent and Duration of the
Metabolic Response
Pain and fear
Traumatic factors:
Post traumatic complications:
Pre-existing nutritional status
Age and sex
Protein and Nitrogen Balance
Protein loss depends on
the severity of the injury
The body tissue affected
Gender, age and state of health of the patient
The nutritional status of the patient
Water, Sodium and Potassium Balance
Water
Sodium
Potassium
Associated Nutritional Problems
Cardiovascular Disease and Injury
Lung Disease and injury
Renal Disease and Injury
Gastrointestinal Disease and Injury
Liver Disease and Injury
Nutrition
Methods to Minimize the Metabolic Response
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Replace blood and fluid losses
Maintain oxygenation
Give adequate nutrition
Provide analgesia
Avoid hypothermia