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% Packages
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%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
\usepackage[normalem]{ulem}     % For underlining links
% Most of the following are not required for the majority
% of cheat sheets but are needed for some symbol support.
\usepackage{amsmath}            % Symbols
\usepackage{MnSymbol}           % Symbols
\usepackage{wasysym}            % Symbols
%\usepackage[english,german,french,spanish,italian]{babel}              % Languages

% Document Info
\author{Michellephillips02}
\pdfinfo{
  /Title (trauma-and-icu.pdf)
  /Creator (Cheatography)
  /Author (Michellephillips02)
  /Subject (Trauma \& ICU Cheat Sheet)
}

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% This two commands together give roughly
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% Commands
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% Header and Footer
\pagestyle{fancy}
\fancyhead{} % Set header to blank
\fancyfoot{} % Set footer to blank
\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
    \SetRowColor{DarkBackground}
    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\end{tabulary}
\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Trauma \& ICU Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Michellephillips02} via \textcolor{DarkBackground}{\uline{cheatography.com/214485/cs/46719/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Michellephillips02 \\
  \uline{cheatography.com/michellephillips02} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 9th July, 2025.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
  \SetRowColor{white}
  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
\end{tabulary}
\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.

\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{x{1.73926 cm} x{1.14425 cm} x{1.69349 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Metabolic Phases}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Ebb Phase}} (12-24 hours, nut not priority) & {\bf{Flow Phase}} (10-14 days) &  \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
{\bf{Ebb-Phase Response}} & {\bf{Acute response}} & {\bf{Adaptive Response}} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
Hypovolaemic Shock & \seqsplit{Catabolism} \seqsplit{Predominates} & Anabolism Predominates \tn 
% Row Count 8 (+ 3)
% Row 3
\SetRowColor{white}
↓metabolic rate & \seqsplit{↑glucocorticoids} & Hormonal response gradually diminishes \tn 
% Row Count 11 (+ 3)
% Row 4
\SetRowColor{LightBackground}
↓ O2 consumption & \seqsplit{↑glucagon} & ↓ \seqsplit{hypermetabolic} rate \tn 
% Row Count 13 (+ 2)
% Row 5
\SetRowColor{white}
↓ BP & ↑N excretion & Potential for restoration of body protein \tn 
% Row Count 16 (+ 3)
% Row 6
\SetRowColor{LightBackground}
↓ Body temp & ↑ BMR & Wound healing (depends on nut intake) \tn 
% Row Count 19 (+ 3)
% Row 7
\SetRowColor{white}
 & Impaired use of fuels &  \tn 
% Row Count 22 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Guidelines \& References}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{ESPEN guideline on clinical nutrition in the intensive care unit (2019)} \tn 
% Row Count 2 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Biochem}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Increased by}} & {\bf{Decreased by}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Serum Albumin}}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
dehydration, marasmus (severe malnutrition), blood transfusion & overhydration, hepatic failure, ascites, eclampsia, protein losing state, cancer, pregnancy, bed rest, trauma/post-op, \seqsplit{inflammation/infection/metabolic} stress \tn 
% Row Count 10 (+ 8)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Serum Prealbumin}}} \tn 
% Row Count 11 (+ 1)
% Row 4
\SetRowColor{LightBackground}
severe renal failure, oral contraceptives & post-op, liver disease/hepatises, infection, dialysis, hyperthyroidism, hyperglycaemia \tn 
% Row Count 16 (+ 5)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Serum Transferrin}}} \tn 
% Row Count 17 (+ 1)
% Row 6
\SetRowColor{LightBackground}
iron deficiency, chronic blood loss, hepatitis, hypoxia, chronic renal failure & pernicious anaemia, overhydration, chronic infection, uraemia (declining renal function), cancer \tn 
% Row Count 22 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.09494 cm} x{3.88206 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Changes to BMR}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{↑ BMR}} & stress, sepsis, fever, pain, adrenaline \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{↓ BMR}} & anaesthesia, sedation, sleep, starvation, continuous feeding \tn 
% Row Count 4 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Nut Reqs}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{START AT HIGH END OF EARLY PHASE (84-105kJ/DAY) – Then lower range of critical illness} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{NEMO – critical illness (105-125kJ/day). Higher end of range in recovery phase} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Awake = moves from critical illness to trauma requirements} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{P}}: NEMO: 1.2-2.0g/kg/day. Lower range.} \tn 
% Row Count 7 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Fluid:}} 30-35ml/kg/day} \tn 
% Row Count 8 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Avoid overfeeding – risk outweighs benefit}}} \tn 
% Row Count 9 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Underweight \& healthy weight = ABW} \tn 
% Row Count 10 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Overweight = IBW} \tn 
% Row Count 11 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Obese = AdjBW (actual body weight - ideal body weight) x 0.33 + ideal body weight)} \tn 
% Row Count 13 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{No guidelines for micros - not a focus in ICU} \tn 
% Row Count 14 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Intervention}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Prevent malnutrition \& catabolism} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Stimulate/facilitate wound healing} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Minimise risk associated with feeding} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Maintain fluid \& electrolyte balance} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Strategies}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Early EN}} (within 12-24 hours) = Reduction in pneumonia, mortality. Improved wound healing, GIT function \& structure, strength \& recovery. o	Aim for goal, or 80\%+, within 48-72 hours} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Gut impaired? = {\bf{PN w/ trophic feeds}} (10-20mL of EN).} \tn 
% Row Count 6 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{ONS, purred diet + moderately thick liquids} \tn 
% Row Count 7 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{HPHE education} \tn 
% Row Count 8 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Reduce fluid}}: restrict IV, diuretic medication, fluid removal via dialysis} \tn 
% Row Count 10 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Consider}}: eeb or flow, Med Hx, usual diet pre-hospital, allergies/intolerances, refeeding risk} \tn 
% Row Count 12 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Monitoring}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{reqs need to be evaluated and recalculated at least once per week}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Wean NGT as oral intake ↑} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{EN: GI S/S} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Swallowing function – w/ speechies} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Example PESS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{P:}} Inadequate protein-energy intake, altered GI function, impaired nutrient utilisation} \tn 
% Row Count 2 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Notes}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{lots of low evidence recommendations due to the nature of the patients – very limited high/Grade A evidence}}} \tn 
% Row Count 3 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}