SystemicResponsetoInjuryandMetabolicSupport.pptVIP

Systemic Response to Injury and Metabolic Support Aaron Lesher 9/1/09 Definitions Infection Identifiable source of microbial insult SIRS 2 or more of the following: Temp 38 or 36 HR 90 RR 20 or PaCO2 32 or mechanical ventilation WBC 12,000 or 4000 or 10% bands Sepsis Identifiable source of infection + SIRS Severe Sepsis Sepsis + organ dysfunction Septic shock Sepsis + cardiovacular collapse (requiring vasopressor support) CNS regulation of inflammation Integral role in inflammatory response that is mostly involuntary Autonomic system regulates HR, BP, RR, GI motility and temp Hormonal Response to Injury Includes: Cytokines Glucagon Insulin Epinephrine Serotonin Histamine Glucocorticoids Prostaglandins leukotrienes ACTH A. Is synthesized in the hypothalamus B. Is superceeded by pain, anxiety and injury C. Continues to be released in a circadian pattern in injured patients D. Causes the release of mineralocorticoids from the adrenal in a circadian pattern ACTH Cortisol Essential for survival during physiologic stress Potentiates the effects of glucagon and epinephrine manifesting as hyperglycemia In liver, stimulate gluconeogenesis Induces insulin resistance in skeletal muscle and adipose tissue In skeletal muscle induces protein breakdown and release of lactate Immunosuppressive agent A primary action of aldosterone is to: A. Convert angiotensinogen to angiotensin B. Decrease Cl reabsorption in the renal tubule C. Decrease K secretion in the renal tubule D. Increase Na reabsorption in the renal tubule E. Increase renin release by the juxtaglomerular apparatus Catecholamine elevation after injury A. Is limited to epinephrine only B. Is limited to norepinephrine only C. Increases by 10- to 20-fold after injury D. Is sustained 24-48 hours before decreasing C-reactive protein A. Is secreted in a circadian rhythm with higher levels in the morning B. Increases after eating a large meal C. Does not increase in response to stress in patients with liver fa