1 / 34

FLUID RESUSCITATION

FLUID RESUSCITATION. CURRENT THINKING Dr Sean R Santos CGH. Objectives. Define Shock Consider methods for recognising the shocked casualty Discuss pre-hospital management In-hospital Management Future Developments. Shock.

Albert_Lan
Download Presentation

FLUID RESUSCITATION

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. FLUID RESUSCITATION CURRENT THINKING Dr Sean R Santos CGH

  2. Objectives • Define Shock • Consider methods for recognising the shocked casualty • Discuss pre-hospital management • In-hospital Management • Future Developments

  3. Shock Failure to achieve adequate perfusion and oxygenation of the tissues

  4. Types of shock • Hypovolaemic • Cardiogenic Inc Tamponade/Tension • Septic • Neurogenic • Anaphylactic

  5. Hypovolaemic Shock

  6. Class I 750 mL (15%) • Slightly anxious • Normal blood pressure • Heart rate < 100 / min • Respirations 14-20 / min • Urinary output 30 mL / hour • Warm skin, Normal Cap Refill

  7. Class II 750-1500 mL (15-30%) • Anxious • Normal blood pressure • Heart rate > 100 / min • Decreased pulse pressure • Respirations 20-30 / min • Urinary output 20-30 mL / hour • Pale, Cool, Cap Refill Delayed

  8. Class III 1500-2000 mL (30-40%) • Confused, anxious • Decreased blood pressure • Heart rate > 120 / min • Decreased pulse pressure • Respirations 30-40 / min • Urinary output 5-15 mL / hour • V. Pale, Sweaty, Cap refill V Delayed

  9. Class IV >2000 mL (>40%) • Confused, lethargic • Hypotension • Heart rate > 140 / min • Decreased pulse pressure • Respirations >35 / min • Urinary output negligible

  10. Pulses • Radial 70-80 mmHg • Femoral 60-70 mmHg • Carotid ≤60 mmHg

  11. Early Indicators • Resp Rate • Colour • Cap refill • Mental State

  12. Management Historical New Strategies

  13. Historical • Two Large Bore Cannulae • Two Litres Of Fluid • Continue Replacement until HR Normal • Control Bleeding

  14. New Strategies Preservation Bleeding Control Fluid Management

  15. Preservation • Rapid Transfer • Surgical/Radiological Management of Bleeding • Permissive Hypotension • Immobilisation of Fractures • Gentle Handling to preserve Clot

  16. PreservationVisible Haemorrhage • Direct Pressure • Indirect Pressure • Tourniquet

  17. Tourniquet

  18. Tourniquets • Proximal • Adequate Pressure • Communication, Orange for Visibility • Aim for max 2 hours • Adequate facilities on release

  19. Clot Promotion • Quick Clot • Dressings • Fibrin Sealants

  20. Pelvic Slings

  21. Fluid Management • Isotonic Fluids • Colloids • Hypertonic Fluids

  22. Stay in circulation Plasma Expand May disrupt Clotting Direct and Dilutional Anaphylaxis ? Cellular acidosis Lesser Volume All fluid compartments No direct effect on Clotting ? Cellular function better preserved Greater volume c. X3 Colloids vs. Crystalloids

  23. Not What How Much

  24. How Much • Pulse Nothing • No pulse 250ml Bolus ? Response ? Repeat • Unconscious Measure BP ≤100 mmHg 250ml ≥100 mmHg Nothing

  25. Route • Big IV Cannula • Intra Osseous

  26. Current/Future Developments • Hypertonic Solutions • Damage Control Resuscitation • Damage Control Surgery

  27. Hypertonic Solutions • 5, 7.5, 10%Saline • +/- Colloid • Rapid, Sustained BP increase • Small Volume • Diuresis • ↓ Intracranial Pressure

  28. Damage Control Resuscitation Damage Control Surgery

  29. Damage Control Resuscitation • Lethal Triad Hypothermia Acidosis Coagulopathy

  30. Damage Control Resuscitation • Permissive Hypotension • Haemostatic Resuscitation • Damage Control Surgery

  31. Haemostatic Resuscitation • Packed Cell 1unit • FFP 1unit • Platelets 1 bag/4-6 • Calcium, Tranexamic Acid, Factor VIIa

  32. Damage Control Surgery

  33. ?

  34. Conclusions Recognition Preservation Small Volume Resuscitation Control Of Bleeding

More Related