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TRAUMA
Sudarsan Agarwal
sushiagarwal@gmail.com
Pinnamaneni Medical College
Vijayawada
JOHN HUNTER
(1794)
• “Treatise on the
Blood, Inflammation and
gunshot wounds”
• “Impressions are
capable of producing or
increasing natural
actions and are then
called stimuli, but they
are capable of producing
too much action as well
as depraved, unnatural
or what we call diseased
action.”
Basic Concepts in Homeostasis
1. Homeostasis is the foundation of normal
physiology.
Cytokine antagonist
• Interleukin receptor antagonist, TNF soluble
receptors are released within hours of injury
Physiological response to injury
Ebb <24 hrs Maintenance of blood Dec BMR, Dec temp, Catechol,
volume, Dec O2 consump, Cortisol,
catecholamines vasoconst, Inc CO, Inc aldosterone
heart rate, acute
phase proteins
Flow
Catabolic 3 – 10 Maintenance of Inc BMR, inc Temp, Inc. Insulin,
days energy inc O2 consump, -ve Glucagon,
N2 balance Cortisol, Catechol
but insulin
resistance
Anabolic 10 – 60 Replacement of lost +ve Nitrogen balance Growth hormone,
(MOORE) days tissue IGF
Ebb
• Starts at the time of injury and lasts for
approximately 24-48 hours
• Main hormones in ebb phase are
catecholamines, cortisol, and aldosterone
• It may be attenuated by proper resuscitation
but not completely abolished
• The main physiological role of this phase is to
conserve both circulating volume and energy
stores for recovery and repair
Flow
• It lasts for several wks
• This phase involves mobilization of body
energy stores for repair and recovery
• Following resuscitation , Ebb phase evolves
into hypermetabolic flow phase, which
corresponds to SIRS
Key catabolic elements of flow phase
• Hypermetabolism
• Alterations in skeletal muscle protein
• Alterations in Liver protein
• Insulin resistance
Hypermetabolism
Majority of trauma patients demonstrate energy
expenditure approximately 15-25% above
predicted healthy resting values