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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 • • Characterized by hypoperfusion Priority is to maintain life/homeostasis Metabolic Response to Trauma: Flow Phase • • • • • 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 1. 2. 3. 4. 5. Replace blood and fluid losses Maintain oxygenation Give adequate nutrition Provide analgesia Avoid hypothermia