Trauma burns

Range of 20-35 kcal/kg per day Maintenance 20-25 kcal/kg per day Repletion/postoperative wound healing/critical illness/sepsis/ 25-30 kcal/kg per day Anabolic//trauma/burns 30-35 kcal/kg per day... 

Daily energy requirements for children are approximately 150% of basal metabolic rate with additional calories to support activity and growth (Table 57-5). Requirements increase with fever, sepsis, major surgery, trauma, burns, long-term growth failure, and chronic conditions (e.g., bronchopulmonary dysplasia, congenital heart disease, and cystic fibrosis). 

High-protein formulations have a nonprotein calorie-nitrogen ratio of less than 125 1. Candidates for these formulations require more than 1.5 g of protein/kg/day and are generally critically ill because of trauma, burns, pressure sores, surgical wounds, or high fistula output. 

May contain fiber kg/day, such as trauma, burns, pressure sores, or wounds. Patients receiving propofol. 

It is indicated in hypovolaemic shock, loss of blood and plasma (e.g., trauma, burns, preoperative autologous blood or plasma donation), and for priming the heart-lung machine. In addition, it can be used as a vehicle for various drugs. 

Administrator, Division of Trauma, Burn Emergency Surgery... 

Physician Assistant Trauma/Burn/Emergency Surgery University of Rochester School of Medicine and Dentistry... 

Stress and exposure to electromagnetic radiation (UV or ionizing radiation) are immunosuppressant. People who bask under artificial UV sun lamps have been found to have suppressed immune responses, as have bereaved individuals. It is known, for example, that the combined effect of exposure to ionizing radiation and physical trauma (burns or wounds) produces a synergistic immunosuppressant effect. 

Trauma, burns, surgery. . Nephrotic syndrome, sepsis, shock... 

Many factors predisposing to infection are related to disruption of the host s integumentary barriers. For example, trauma, burns, and iatrogenic wounds induced in surgery may lead to a substantial risk of infection depending on the severity and location of the injury or disruption. For a complete discussion of the various risks involved in surgical procedures, see Chap. 121. 

Hypermetabolic states such as trauma, burns, and sepsis Digestive or absorptive disease, nausea, vomiting, or diarrhea Hyperlipidemia Prematurity End-organ effects Weight change or failure to thrive Skin or hair changes... 

One of the characteristics of critical illness is hypermetabolism. Trauma, burn injury, and sepsis are aU catalysts for the release of mediators that initiate and regulate the hypermetabohc response. The metabolic consequences of this response include altered carbohydrate metabolism, increased protein synthesis and degradation, and increased lipid oxidation, which ultimately result in loss of protein and lean body mass." In a previously well-nourished individual, critical illness can result in the onset of kwashiorkor-like malnutrition within 5 to 7 days. In a previously malnourished individual, critical illness can precipitate severe mixed marasmus-kwashiorkor in 3 to 5 days. In a prospective study of 129 patients admitted to the intensive care unit (ICU), 43% were malnourished." The malnourished patients had an increased length of stay in the ICU (a mean of 27 vs. 19 days) and a statistically significantly increased incidence of complications (55% vs. 40%) compared with well-nourished patients with a similar severity of illness. 

Critical reviews of available randomized controlled trials comparing EN to PN in the critically ill adult patient with an intact GI tract suggest a significant reduction in infectious complications associated with EN. Decreased infectious complications have been documented in patients with abdominal trauma, burns, or severe head injury given EN compared to PN. The use of EN has been recommended over PN as the preferred route of feeding in the critically ill patient requiring specialized nutrition support. ... 

Associate Professor of Surgery, Division Chief, Trauma/Burns/Surgical Critical Care, Department of Surgery, University of New Mexico Health Sciences Center,... 

Hypericum was widely used in the folk medicine of a number of European countries as a shooting agent, an antiphlogistic in the treatment of inflammation of the bronchi and the urogenital tract, a hemorrhoid treatment, and a heahng agent in the treatment of traumas, burns and scalds, ulcers of various kinds, and other local and general illnesses [116]. 

THROMBATE III (Bayer) is a plasma-derived product that is used to treat AT-III deficiency, the first inherited trait discovered which was identified in 1965. The condition is associated with thrombophilia caused by low levels of AT-III or the presence of altered AT-III activity. Both conditions can result in excessive blood clotting. Acquired AT-III deficiency is another condition that occurs in situations with high risk of thrombosis such as trauma, burns, and sepsis. GTG Biotherapeutics conducted chnical trials with ATryn in high-risk situations such as surgery or child de-Hvery to prevent deep-vein thrombosis in hereditary AT-III-deficient patients and heparin-resistant patients with acquired AT-III deficiency undergoing coronary bypass. A pharmacokinetic study in patients with hereditary AT-III deficiency indicated that the administration of the recombinant product resulted in an increase in blood... 

In addition to ensuring adequate nutrition, some investigators believe that other therapies may enhance patient recovery following trauma, burns or severe infection.. Strategies which reduce the inflammatory response and enhance protein synthesis and tissue repair are being evaluated. 

Wisser D, Steffes J (2003). Skin replacement with a collagen based dermal substitute, autologous keratinocytes and fibroblasts in burn trauma. Burns. 29 375-380. 

We had to acknowledge that we could not specify the degree to which radiation had been responsible for the morbidity and mortality, These women had suffered extensive trauma, burns, malnutrition, and infection, each of which could have had a role in the negative pregnancy outcomes. 

Finally, both constant infusion and pulse label techniques using isotopic labels to estimate whole body protein turnover share the common premise that there is a homogeneous metabolic nitrogen pool of which the plasma constitutes an integral part. That this is in fact an oversimplification, has been shown from animal studies [438]. Despite these, and other objections, work will continue in the search for a reliable method for the estimation of protein synthesis, catabolism and turnover in man. To the clinician such a method would provide information about nitrogen loss from the body resulting from malnutrition, postoperative trauma, burns or severe infection and perhaps more importantly an indication of the success or otherwise of the specific therapeutic regime implemented. 

Other circumstances predispose to significant malnutrition in subjects of any age. Severe trauma, burns, or sepsis are hypermetabolic states requiring massive nutritional support such as hyperalimentation. Nutrition in acutely and chronically ill patients is often inadequate. Even in an informed, affluent society, some people, such as alcoholics, are inadequately nourished because of overconsumption of foods of low nutritional value. For example, wet beriberi has reappeared among Japanese teenagers who subsist on soft drinks, noodles, and polished rice (Kawai et aL, 1980). Macrobiotic vegetarians are prone to the neurologic complications of Bj2 efficiency after years of such a diet. 

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