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MSK > Systemic Response to Trauma > Flashcards

Systemic Response to Trauma Flashcards

1
Q

Milieu interieur

A

Internal responses to injury

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2
Q

Shock of all forms is related to…

A

inadequate delivery of oxygen and nutrients to tissues.

Low flow state in in vital organs is common in all forms of shock.

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3
Q

In severely injured patient, shock is nearly always result of…

A

loss of circulating blood volume due to hemorrhage.

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4
Q

Shock in traumatized patients has two effects:

A
  1. Perfusion to vital organs is decreased from blood loss/myocardial dsyfunction.
  2. Oxygen delivery to tissues is decreased due to loss of RBC from hemorrhage or alterations in dissociation of oxygen from Hb.
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5
Q

Two physiologic responses to hypovolemia. What are they?

A
  1. Tachycardia occurs in response to reduction in intravascular volume. Cardiac output is maintained by HR*SV.

HR is increased via adrenosympathetic pathways so CO is maintained.

  1. Increased peripheral vascular resistance occurs with shock. Systolic blood pressure is maintained by CO and SVR (peripheral vascular resistance). SVR increased via adrenosympathetic pathways as homeostatic controls attempt to maintain systolic BP.
    SVR increases greatly in kidneys and skin shunting blood to vital organs.
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6
Q

Two physiologic responses to hypovolemia. What are they?

A
  1. Tachycardia occurs in response to reduction in intravascular volume. Cardiac output is maintained by HR*SV.

HR is increased via adrenosympathetic pathways so CO is maintained.

  1. Increased peripheral vascular resistance occurs with shock. Systolic blood pressure is maintained by CO and SVR (peripheral vascular resistance). SVR increased via adrenosympathetic pathways as homeostatic controls attempt to maintain systolic BP.
    SVR increases greatly in kidneys and skin shunting blood to vital organs.
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7
Q

When systolic BP is decreased in injured patient, a significant loss of blood volume has occurred. True or false?

A

True.

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8
Q

Class I hemorrhage is defined as…

A

Loss of up to 15% of circulating blood volume (750 cc). Compensatory responses maintain blood pressure and pulse.

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9
Q

Class II hemorrhage is…

A

Loss of 15-30% of blood volume (800-1500 cc) and signs include tachycardia, sluggish capillary refill, and oliguria.

Systolic BP remains normal maintained by SVR.

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10
Q

Class III hemorrhage…

A

Loss of 30-40% of blood volume (1500-2000 cc). Signs: Tachycardia, sluggish capillary refill, oliguria, tachypnea, decreased systolic bp.

Loss of 30% of circulating blood volume is required before systolic hypotension occurs.

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11
Q

Class IV hemorrhage is…

A

Loss of greater than 40% of blood volume (>2000 cc) and is characterized by profound hypotension, anuria, and absence of capillary refill. Life-threatening exsanguination and replacement of blood volume immediately needed.

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12
Q

Two primary stimuli induce neuroendocrine response to injury.

A

Afferent nerve stimulation (pain) and hypovolemia.

Pain is most important factor.

Baroreceptors in atria and great vessels which sense hypovolemic and release tonic inhibition of secretion of ACTH, ADH, and growth hormone are important too.

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13
Q

ACTH does what during trauma?

A

Stimulates secretion of other hormones: renin, aldosterone, epinephrine, norepinephrine, vasopressin (ADH), growth hormone, and glucagon.

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14
Q

What are effects of endocrine response?

A
  1. Conservation of water and salt (renin, aldosterone, ADH).

2. Maintenance of blood pressure (renin, epinephrine, ADH, aldosterone)

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15
Q

What are effects of endocrine response?

A
  1. Conservation of water and salt (renin, aldosterone, ADH).
  2. Maintenance of blood pressure (renin, epinephrine, ADH, aldosterone)
  3. Mobilization of carbohydrate (epinephrine, ADH, growth hormone, glucagon)
  4. Lipolysis (epinephrine, growth hormone, glucagon)
  5. Provision of oxygen and nutrients to the vital organs.
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16
Q

Local mediators: Facts

A

Histamine, serotonin, prostaglandins, adenosine diphosphate (ADP), collagen, complement cascade, endotoxins, kinins,
potassium.

These are important for hemostasis, inflammation, and repair of tissues.

17
Q

Local mediators are released more slowly or faster than hormonal mediators?

A

More slowly. They are released during first 24 hours.

18
Q

These local mediators cause platelet adhesion and local hemostasis and blocking fibrinolytic system=DIC (disseminated intravascular coagulation).

A

ADP and collagen (systemic).

19
Q

Injury induces which metabolic responses?

A

Hyperglycemia and fatty acid mobilization.

FFA elevated in serum for weeks following severe injury.

Trauma stimulates catabolism of muscle protein beyond that needed to fill energy demands.

Nitrogen balance will not return to positive (anabolic) for weeks after severe injury.

20
Q

What happens to extracellular osmolality in weeks after severe injury?

A

Increased extracellular osmolality and increased vascular permeability result in increased extracellular water content seen as generalized edema.

ECF is elevated for 1-2 weeks after severe injury.

21
Q

What happens to oxygen consumption in weeks after severe injury?

A

Multiple fractures: Increase in O2 consumption by 25%.

Severe burns/sepsis: 50-100% increase in O2

22
Q

Hb dissociation curve changes after severe injury?

A

Curve shifts to right to allow greater delivery of oxygen to tissues at any given tissue oxygen tension.

This decreased affinity of Hb for oxygen is good!

Severe trauma cause hypoperfusion and hypoxia which cause right shift in Hb dissociation curve. 2,3 DPG binds to Hb and decreases affinity of Hb for oxygen.

Acidosis also shifts the curve right.

Hypothermia and anemia shift curve left: SO must warm patient and replace blood volume in treatment of trauma.

23
Q

Hb dissociation curve changes after severe injury?

A

Curve shifts to right to allow greater delivery of oxygen to tissues at any given tissue oxygen tension.

This decreased affinity of Hb for oxygen is good!

Severe trauma cause hypoperfusion and hypoxia which cause right shift in Hb dissociation curve. 2,3 DPG binds to Hb and decreases affinity of Hb for oxygen.

Acidosis also shifts the curve right.

Hypothermia and anemia shift curve left: SO must warm patient and replace blood volume in treatment of trauma.

24
Q

Trauma Score: What is it?

A

Glasgow Coma Scale and cardiopulmonary function.

High for normal
Low for impaired
Low=1 and High=16

MSK (8 decks)

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