1. Burns trauma sepsis GICardiacRenal Cancer Full thickness

2. 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

3. 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)

4. What’s Going On During “Ebb”? Low cardiac output; low tissue perfusion. 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. NO ADDITIONAL NUTRITION SUPPORT NEEDED!!!!!!!

5. What’s up in “Flow”? 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.

6. Immediate Needs to Sustain Life: 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.

7. 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