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Full thickness
Burns
GI
Cardiac
trauma
sepsis
Renal
Cancer
Injury, Trauma, Surgery
Neurohormonal Activation of the Stress
Response
Glucocorticoid & Catecholamine
Activation, Hi Glucagon:Insulin
Ratio, Growth Hormone Release
Tachycardia, Tachypnea, Hyperglycemia,
Mobilization of Body Fat, Massive Catabolism
of Skeletal Muscle
In Critical Illness, Timing of Assessment is
Extremely Important!
Why?????
Metabolism in critical injuries
Goes through at least three
Distinct phases:
Ebb (1st 24 hrs post-injury)
Flow (Days 2-5)
Anabolic (7-10 days)
What’s Going On During “Ebb”?
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Low cardiac output; low tissue perfusion.
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Main priority is maintaining tissue perfusion.
(RESUSCITATION)
Substrate utilization depressed; cell functions
depressed.
Increased catecholamines (epinephrine,
norepinephrine) increase production of
energy substrates (glucose, ffa, amino acids)
to ESCAPE injury, MAINTAIN blood volume.
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•
NO ADDITIONAL NUTRITION SUPPORT NEEDED!!!!!!!
What’s up in “Flow”?
•
•
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High cardiac output;
Growth hormone, glucagon, cortisol
all increased (catabolic hormones)
These cause increase insulin secretion
Insulin resistance may develop and
cause hyperglycemia.
•
•
Increase BMR; glycogen now depleted.
Positive N balance cannot be achieved.
Immediate Needs to Sustain Life:
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•
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Restore blood flow;
Maintain oxygen transport;
Prevent/treat infections.
If malnourished, introduce nourishment
cautiously, if not-Refeeding syndrome: malabsorption, cardiac
insufficiency, respiratory
distress, CHF, etc.
Fluid and Electrolytes
Many types of stress can cause massive
fluid losses.
Examples:
Severe burns= lose 12-15%
of BW is FIRST 24 hours!
Vomiting, diarrhea, wounds,
bleeding, and FEVER