Response to Injury

1
Response to Injury

• Pathophysiology 4th year

2
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

3
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

4
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

5
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

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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

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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

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Water, Sodium and Potassium Balance

• Water
• Sodium
• Potassium

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Associated Nutritional Problems

• Cardiovascular Disease and Injury
• Lung Disease and injury
• Renal Disease and Injury
• Gastrointestinal Disease and Injury
• Liver Disease and Injury

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Methods to Minimize the Metabolic Response

• Replace blood and fluid losses
• Maintain oxygenation
• Give adequate nutrition
• Provide analgesia
• Avoid hypothermia