Physiotherapy Trauma Talks
In Physiotherapy Trauma Talks we discuss the key roles that physiotherapists and other healthcare practitioners play in the management and rehabilitation of patients with traumatic injury. Experts in trauma care offer their insights about in-hospital patient care and post-discharge follow up service delivery. New research in the field of trauma care and rehabilitation is shared to provide answers to your questions.
Physiotherapy Trauma Talks
The Vital Role of Diet in Trauma Care: with Chantal Mostert
Discover how nutrition is the unsung hero in trauma recovery care in our latest episode! Join me in conversation with Chantal Mostert, a dedicated dietician from the trauma intensive care unit at Netcare Milpark Hospital. In this enlightening conversation, we explore the vital role that nutrition plays for patients recovering from traumatic injuries, unveiling how tailored eating plans can drastically enhance healing and improve outcomes.
The synergy between dieticians and physiotherapists also takes center stage as we discuss how collaborative teamwork is critical for patient recovery. Anyone involved in trauma care will gain valuable insights into the importance of early nutritional interventions and methods for tracking progress.
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Podcast website: https://physiotherapytraumatalks.buzzsprout.com
‘Cardiopulmonary Physiotherapy in Trauma: An Evidence-based Approach’ published by World Scientific: https://doi.org/10.1142/13509
Hi there, fellow physiotherapists. I am Helene van Asvegen, your host for Physiotherapy Trauma Talks, where we discuss everything related to trauma care. So if you are passionate to learn more about physiotherapy in the field of trauma to ensure that you provide the best possible care for your patients, then this is the right podcast series for you. Right Today, my guest is Chantal Mostert. Chantal is a dietician who works in the trauma intensive care unit at NICM Mill Park Hospital and has got vast experience in dietetic care for patients with traumatic injuries. Chantelle, thank you for joining me today. Thank you for having me today. Chantelle, could you introduce yourself to our listeners and then just explain a little bit how you came about to work in trauma?
Speaker 2:care. So I studied at University of Stellenbosch and once I finished studying, a few years later, at first I started working at Moorpark Hospital, generally throughout the hospital, but then I got a little bit more involved on the trauma side and starting to see patients in the trauma units with enteral feeds as well as patients requiring nutritional supplements, and I've been working at Moorpark since 2007. That's wonderful.
Speaker 1:Chantal, we know that nutrition is a basic human right. I was wondering how do the nutritional needs of patients who sustain traumatic injury change?
Speaker 2:So when we look at a patient that has had any kind of traumatic injury, we always use the analogy thinking of when you get bitten by a tiger when you're living in a field, and then often what would happen is that person would not be eating for the first day or two, and then they basically have two options they either need to get up and continue or otherwise that person will probably pass away.
Speaker 2:But now, with medical interventions that's come about in the last few years, the medical care has become better and better. So our bodies are actually not metabolically adapted to critical illness and to deal with trauma. So what we do see in a patient that comes in with any type of traumatic injury is there's definitely a very big change in their metabolic response to the trauma. So therefore they would use a lot of their muscle mass as the energy fuel source in the body. And what is very important is that we start with our nutrition in the correct way. So, which means that we need to start off early but slowly in the first few days, but then also paying a lot of attention to making sure patients get adequate nutrition, and especially when we get to the later phase of illness, where patients are recovering and require more intensive physiotherapy. That's the time also when the protein requirements dramatically increase.
Speaker 1:Thank you very much for that explanation Based on your clinical experience. What would you say or how would you describe the role of the dietician in the trauma intensive care or high care setting?
Speaker 2:So I think when we look at a multidisciplinary team and every person that's involved in that multidisciplinary team, I always say that every person is an ambassador for something in the care of that patient. So where the physiotherapist would be an ambassador for mobilization and looking after making sure there's good range of motion and recovery, our role is then to make sure that we are supporting that recovery process. Role is then to make sure that we are supporting that recovery process. So it is absolutely very necessary that patients that are critically ill after a trauma injury, as well as patients requiring any additional support, should see a dietician. For example, we would often see patients with facial fractures, so physically they would not be able to eat very well due to their injuries, and it's extremely important that we're still meeting their requirements Because at the end of the day, when a physiotherapist wants to get them out of bed to do the rehabilitation process, it would not be possible if the patient's not getting adequate calories and protein would not be possible if the patient's not getting adequate calories and protein.
Speaker 1:Yes, and I think it's great that you mentioned that each professional that's involved in the care of a patient with traumatic injury is an ambassador for something. I like that analogy. Would you say that there is a difference in the nutritional needs of patients with different types of traumatic injury? For instance, a patient who sustained burn injury versus a patient who has mostly chest-related trauma?
Speaker 2:So I think what will happen is usually when we see a patient, we would do a full assessment and look at all the injuries combined. What will often happen is you might have see a patient, we would do a full assessment and look at all the injuries combined. What will often happen is you might have polytrauma, which will definitely increase the patient's requirements. Patients with chest injuries, depending on whether they have chest drains as well, because you will lose protein as losses through the chest drains. So you would need to take everything in consideration.
Speaker 2:Traumatic brain injuries also do require a little bit higher amount of protein, and that is just because the brain, for it to recover, and that recovery process, requires more protein and increases the energy requirements of the patient. And then, on the upper range of the scale, definitely would be the burns patients. So, due to the extent of the injury, the inability to keep the body temperature, as well as the extensive amount of wounds that need to be healed, they require some of the highest amounts of protein and energy that you would give a patient in any situation. So that would be approximately two and a half grams per kilogram, where something like, for example, your patient that has just had a chest injury will require 1.2 gram per kilogram, so it would be somewhere in that range, and the same will go for energy as well.
Speaker 1:Okay, so I would assume that daily reassessment of patients in the trauma ICU is quite important to ensure that you do meet those nutritional needs of the patient.
Speaker 2:Yes, that's correct. We also need to monitor and make sure that, looking at the blood results of patients, looking at how the feeds are tolerated because you can have the best plan to that a patient might be suffering from nausea or vomiting or might start having loose stools, and then we have to reassess that and change it. We also do sometimes give specialized nutrients that will help for wound healing, and it's extremely important to monitor liver function and kidney function to make sure that there's no complications due to the therapy that we're giving.
Speaker 1:Sure, that really sounds like quite a big job to make sure that the patients get enough nutrition on board. So you have covered my next question already a little bit about factors that influence a patient's feeding routine, and you've mentioned that patients may be nauseous or vomit or may have diarrhea. Are there any other factors that impact on a patient's feeding?
Speaker 2:routine.
Speaker 2:So I think one of the biggest things that we first need to establish is what is the route that we're going to use.
Speaker 2:So when a patient arrives through the trauma unit, after doing a proper assessment, if a patient is able to eat orally, the oral route is always the best route to follow.
Speaker 2:If we anticipate that the patient will be unable to eat an adequate amount of nutrition, for example with facial fractures, then it might be necessary for enteral nutrition. Obviously, our patients that are ventilated will all receive enteral nutrition. And then, on the extreme, if there's any type of abdominal injuries where we don't have a functional digestive system, we would then place the patient onto TPN. So that is the first thing that we need to consider, and then the second thing is also the amount of protein, based on the specific case of the patient, and that's why I think trauma patients are so interesting to work with, because it's never the same case. Every person's injuries are different, so it's very much a tailored plan. We also take things like, for example, age of the patient into consideration, any pre-existing comorbidities for example pre-existing dementia or age-related deterioration that patient would be at a higher risk of nutrition failure. So therefore, we will need to start with more aggressive ways of feeding them sooner or earlier, because that would influence their nutritional intake.
Speaker 1:Chantal, earlier in our discussion you spoke about working with the physiotherapists. Would you mind just elaborating a little bit more on that, particularly in your setup here at Moorpark Hospital in the trauma ICU Sure?
Speaker 2:I think, yes, it's very important to work and have a very good relationship with a physiotherapist.
Speaker 2:I feel that we often rely a lot on them and they also rely a lot on us to get a patient better.
Speaker 2:So a physiotherapist can definitely help assist us with establishing when patients are extubated in terms of getting the speech therapist involved for a swallow assessment, because often I think the physiotherapist spends quite a lot of time giving the patient instructions, so they're a very good person to go to to ask whether a patient is already starting to obey a little bit of commands, because then it would be the right time to start doing a swallow assessment and start establishing oral intake.
Speaker 2:We also rely on the physiotherapist to help us to weigh patients, because often patients are not able to mobilize very well on their own independently, and so we do coordinate with the physiotherapist. And then the way that we need to help a physiotherapist would definitely be to, you know, make sure that we're getting to our nutritional requirements of the patient, as well as making sure that you know we're getting enough protein in for the patients. And it's interesting because the physios can be very, very proactive for us. We, after mobilization, when they put the patient in the chair. They usually move the table closer with the incentive spirometer and automatically they put the subfeed right next to it, so the patient has access to both of them.
Speaker 1:Wonderful to both of them. Wonderful Chantal, how do you, on a daily basis, ensure that you and the physiotherapist have the same plan for the patient, or how do you discuss your plan? So I guess I want to ask how do you maintain communication between your two teams?
Speaker 2:I think a lot of the times we do do rounds ward rounds in the mornings at similar times, so we can have informal discussions with a physio. If there's something that we need to discuss in terms of whether a patient needs to be weighed or if they feel that they are concerned about a patient's intake, we would do that. We do communicate as well via the care on our electronic system for note keeping and then once a week at Mill Park Hospital we have a multidisciplinary team meeting where we would sit down and formally discuss all the patients that are in the trauma and the burns unit, and this is to ensure that each person is on the same page of what has happened for the week that has passed and what is planned for the week that's ahead.
Speaker 1:Okay, yeah, so wonderful multidisciplinary approach to patient care. When patients recover to the point where they are ready for discharge from the hospital, do you have a follow-up clinic for some of them, or?
Speaker 2:how does the role of the dietician change in from here mostly to the rehab facility at Auckland Park, where they would still continue with their care? So what we would usually do is we do a handover from Moorpark Hospital onto the Auckland Park rehab facility so that the dietician on that side can then continue with the care.
Speaker 1:Okay, wonderful. So, as we wrap up our discussion, are there any last thoughts that you would like to share with our physiotherapy listeners?
Speaker 2:I think when it comes to managing trauma in Burns patients, it is extremely crucial to remember and understand that it is a multidisciplinary team approach and that not one person on their own would be able to get the patient to their full capacity. Working as a team is extremely important. Probably one of the most important places in the hospital where a multidisciplinary team can make a difference is ensuring that everybody is involved that can help to get the best outcome for patients.
Speaker 1:Chantal, thank you so much for a lovely discussion and for your time. I appreciate it. Thank you so much.
