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Severe Traumatic Brain Injury, Kabi Glutamine (0.2-0.3g/kg/d), VL+C …
Severe Traumatic Brain Injury
Forehead Laceration:
10 cm long, 4 cm deep,
& visible skull
Wound healing
Increased protein
requirements
Initiates
metabolic
stress
response
Controlled CHO decrease
hyperglycemia
60 + NPE
Snack state
Required fluids
Ringers Lactate
System
Inflammation
Increased CPR
Anaemia chronic disease
Increased production
pro-inflammatory cytokines
Hypercatabolism
Increased proteolysis
Hypermetabolism
Increased metabolic
demand
Increased energy
requirements 26kcal/kg/d
Pain
Increased BP
Nausea/vomiting
Maxalon
Management
Potential Complications
Seizures
Permanent damage / disability
Increased
QOL
Brain Bleed
Kabi
Glutamine
(0.2-0.3g/kg/d)
Neurological
support +
protection
x1 Sachet
Immune
support
Increased WBC
Increased procalcitonin
Monitor
carefully
with kidney
function
Increased urea
Increased creat
Increased protein
requirements
1.3g/kg/d
Poor
wound
Healing
VL+C
deficiency
90mg/d
Collegen
synthesis
Smoking history
Bicycle
accident while
intoxicated
Laceration to
L knee
CXR
No visible tibia
No visible bone,
6 cm wide + 4 cm deep
Caused by outside force to head
Injury to eye
Infected
Chloramax
Ointment
CT Brain
Multiple Facial Fractures
GCS
6/10
Neurological
Impairment
Often long-term
effects
Feeding
impairments
Insuffisant
oral intake
Alternative
feeding route
Placement
NGT
Enteral Nutrition
Nutrison
PPMF
@ 40ml/hr
Increased to 60ml/hr if tolerated
Long-term
placement
PEG.
Structural +
functional
damage
brain
tissue
Surgical
procedure
Tracheostomy
intubation
Inability
eat
orally
Difficulty
breathing
Blood
loss
Anaemia
chronic
disease
2n deficiency
11mg/d
Verbal
impairment
Require multidisciplinary approach rehab
Physical/motor
impairments
Decreased mobility weakness R arm
Loss lean muscle mass due no mobilisation
& wasting clavicle
region
Decreased CC = 33.6cm
Decreased MUAC = 28.4cm
aspiration/vomiting
abdominal distension
Decreased CBC
Decreased Hb
Decreased Hct
Gram + +3
Gram - +2
Systemic/
bacterial
infection
Forehead +
L Knee
Laceration
Increased K+
Perfalgen
Tramadol
Clexane prophalaxis
Test
RDOQI 2020
can
cause