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26 Cards in this Set
- Front
- Back
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Purpose of inflammatory response
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1. restore tissue function
2. eradicate microorganisms |
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2 phases of inflammatory response to injury
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1. proinflammatory - acitvate cellular processes to restore tissue function and eradicate micoorganisms
2. anit-inflammatory to restore homeostasis |
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SIRS Criteria
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2 or more:
Temp ≥38◦ C or ≤36◦ C Heart rate ≥90 beats/min RR ≥20 breaths/min Paco2 ≤32 mmHg or mechanical ventilation WBC ≥12,000/μL or ≤4000/μL or ≥10% band forms |
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Sepsis
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indentifiable source of infection + SIRS
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Severe Sepsis
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Sepsis + organ dysfunction
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Septic shock
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sepsis + CV collapse (requires vasopressor support)
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How long do cortisol levels stay elevated in burn patients?
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up to 4 weeks
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Physio effects of cortisol
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potentiates glucagon and epi resulting in hyperglycemia
stimulates gluconeogenesis, but IR in muscle/adipose protein degradation in muscle-->lactate for gluconeogenesis potentiates release of FFA/TG/glycerol for add'l energy sources |
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sx of acute adrenal insufficiency
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weak, N/V/F, hypotxn
hypoglycemia (decreased gluconeogenesis) hyponatremia/HYPERkalemia (worse w/ aldo deficiency) |
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Macrophage inhibitory factor (MIF)
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glucocorticoid antagonist from ant pit or T lymphs at site of imflammation
Pro-inflammatory, potentiates gram - and + septic shock |
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function of aldosterone
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ACTH stimulated, released from Zona glomerulosa
maintain intravasc volume: conserve Na, eliminate K/H in early DCT |
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Aldosterone deficiency sx
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hypotension
Hyperkalemia |
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Aldosteron Excess sx
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edema, HTN, hypoK
metabolic alkalosis Aldo promotes reuptake of Na in exchange for K and H in DCT |
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best acute phase protein as marker of injury?
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only CRP consistently used b/c it reflects inflammation trend (better than ESR)
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Serotonin effects
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vasoconstriction
bronchoconstriction platelet aggregation from chromaffin cells of intestine and platelets |
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H1 vs H2 receptor
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H1: bronchoconstriction, intestinal motility, myocardial contractility
H2: inhibits histamine release Both: hypotension, peripheral pooling of blood, increased cap perm, decr venous return, myocard failure increased Histamine a/w hemorrhagic shock, trauma, sepsis |
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energy requirements of post-surgical pts
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30 kcal/kg is ballpark for most pts with low overfeeding risk
increased demands and energy expenditure w/ trauma/sepsis--need more non-protein calories 1.2-2x calculated resting energy expenditure |
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nitrogen needs
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0.25-0.35g nitrogen/ kg body wt daily
*except w/ renal or hepatic dysfunction |
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advantages of enteral vs paranteral feeding
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reduced cost, reduced risk of iv route
reduces intestinal atrophy by luminal contact of nutrients decreased infection rates post op and acute phase reactant production |
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early enteral feeding
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no strong data for moderate malnutrition (alb 2.9-3.5 g/dL)
recommended if permanent neuro impairment, short bowel, bone marrow tx good data for after major trauma and anticipated prolonged recovery |
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How long can healthy pts undergoing uncomplicated surgery tolerate partial starvattion (iv fluids only)?
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up to 10 days before significant protein catabolism occurs
rec. earlier intervention for worse preop nutrition |
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enteral feeding: NG tube
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short term only
aspiration risk nasopharyngeal trauma frequent dislodgement |
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enteral feeding: nasoduod/jejunal
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short term use
lower aspiration risk in jej placement challenging (requires rads) |
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enteral feeding: PEG
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need endoscopy
for gastric decompression or bolus feeds aspiration risks lasts 1-2 years risk of site leaks |
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enteral feeding: surgical gastrostomy
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requires GETA w/ laparotomy/oscopy
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PPN
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lower omolarity:
reduced dextrose (5-10%) reduced protein (3%) not for sever malnutrition, short periods less than 2 weeks. |
