1 / 23

FLUID RESUSCITATION TRAUMA PATIENT

FLUID RESUSCITATION TRAUMA PATIENT . Author; Prof.MEHDI HASAN MUMTAZ Consultant Intensivist/ Anaesthetist Christie Hospital,Manchester,U.K. FLUID THERAPY . Questions

robert
Download Presentation

FLUID RESUSCITATION TRAUMA PATIENT

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 TRAUMA PATIENT Author; Prof.MEHDI HASAN MUMTAZ Consultant Intensivist/ Anaesthetist Christie Hospital,Manchester,U.K.

  2. FLUID THERAPY • Questions 1,Does the pt.need fluids ? 2,How much he/she needs ? 3,What type of fluid is needed ?

  3. STATUS OF HYDRATION • Intravascular Haemodynamics • Interstitial Skin fold • Intracellular thirst,confusion,coma,death confusion,convulsion,coma,death

  4. FLUID RESUSCITATION • 1. Prehospital phase • 2. Hospital phase Resuscitative ( A&E) Operative (OR) Critical care (HDU,ICU)

  5. PRE-HOSPITAL PHASE ;DILEMMA; Definitive Hmge control –No Inadequate Resus. -Mortality Full Resus. -Hmge

  6. PREHOSPITAL PHASE • Two schools of thought Scoop & Run, Target, ;palpable pulse; Stay & Play, Necessitate, control bleeding (Thoracotomy,Laparotomy)

  7. PREHOSPITAL PHASE • Resuscitation Fluid 1 ;Colloid vs crystalloids; 2 ;Iso-osmolar/oncotic vs hyper-osmolar/oncotic; 3 ;Saline vs Lactated Ringer;

  8. CONSENSUS VIEW Emergency Medicine Journal 2002;19;494-498 Revell M,Porter K,Greaves I.

  9. FULL TEXT ;Fluids should not be administered to a trauma patient before haemorrhage control if radial pulse can be felt,if not,give boluses of fluid challenge(250 mls) till the pulse is palpable.Now Suspend fluid therapy & monitor the situation.;

  10. Reference • Bickel WH, Wall MJ, Jr., Pepe PE,et al. Immediate versus delayed resuscitation for hypotensive patients with penetrating torso injuries.New England Journal of Medicine 1994;331: 1105-1109.

  11. TABLE

  12. TABLE

  13. 2- HOSPITAL PHASE • :Continuum from field: EXPERIENCE + EQUIPMENT ;The key is the time to control surgical haemorrhage;

  14. 2-HOSPITAL PHASE • Best available evidence based approach to furthure resuscitation in the same way as any other critically ill patient; • AIM; Restore full circulation and optimal perfusion of all tissues guided by monitoring

  15. TYPES FLUIDS • COLLOIDS:- Efficient No edema Expensive Affect Co-agulation

  16. TYPES OF FLUIDS • CRYSTALLOIDS:- Less expensive/unit Less efficient Cause oedema eg,Abdominal compartment syndrome

  17. TYPES OF FLUIDS • 0.9% SALINE VS R.LACTATE Hyper tonic Hypo tonic Acidoses Acidoses Redce R.Function No effect Reduce G.I.perfu- No effect -sion

  18. TYPES OF FLUIDS • BLOOD & BLOOD PRODUCTS Expensive Availability O2 Delivery Coagulopathy correction Target > 10G /dl

  19. RECOMMENDATIONS • 0.9% SALINE, Resuscitation fluid of choice both in field & Hospital untill head injury is ruled out Lactated RINGER, For hydration in non head injured COLLOIDS, For volume resuscitation

  20. TYPES OF FLUIDS HYPERTONIC & HYPER ONCOTIC SOLUTIONS PERFLUROCARBONS & STROMA FREE HAEMOGLOBIN SOLUTIONS ; ExpermentAL PRODUCTS;

  21. SUCCESSFUL RESUSCITATION • REQUIRES:- ;early restoration of Heart-Lung-Brain circulation to avoid immediate death; 50% BV replacement required to restore a viable Heart-Lung-Brain circulation in non anaesthetised,non sedated patient 100% BV replacement to reperfuse all organs,especialy Splechnic bed

  22. HOSPITAL PHASE - HDU/ICU Specialised care + Advanced monitoring + Multi-organ support

  23. CONCLUSION 1,Restore pulse with boluses of Saline 2,Transfer to hospital,control bleeding,exclude head injury,then Ringer lactate for hydration and synthetic colloids for volume resuscitation. 3,Blood/products—early 4,Saline-choice for early Resus

More Related