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Fluid and blood resuscitation

Fluid and blood resuscitation. intro. Hemorrhage Thorax Abdomen Gynecologic orthopaedic Burns GI disorders Environmental losses. Fluid rescusitation. Goals: to restore intravascular volume sufficient for critical organ perfusion

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Fluid and blood resuscitation

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  1. Fluid and blood resuscitation

  2. intro • Hemorrhage • Thorax • Abdomen • Gynecologic • orthopaedic • Burns • GI disorders • Environmental losses

  3. Fluid rescusitation • Goals: • to restore intravascular volume sufficient for critical organ perfusion • to maintain oxygen-carrying capacity for adequate cellular oxygen delivery • to correct derangements in coagulation. • Aggressive resuscitation may actually accelerate RBC loss, so “permissive hypotension” may be used in initial phase. • Not recommended by ATLS

  4. Pathophys

  5. pathophys • Hemorrage -> endothelial damage -> clotting cascade and vasoconstrictive mediators • Lethal Triad • Acidosis • Hypothermia • coagulopathy

  6. Clinical features

  7. Pearls • Elderly patients may not develop a tachycardic response to blood loss due to underlying heart disease or medications such as beta-adrenergic blockers.

  8. pearls • Bradycardia or lack of tachycardia may occur in about 30% of patients with intra-abdominal hemorrhage from increased vagal tone in response to hemoperitoneum

  9. pearls • In a pregnant trauma patient, compression of the inferior vena cava by the gravid uterus can decrease central venous return and worsen hypotension and tachycardia in the setting of less severe hemorrhage.

  10. treatment • ACBCD • Control hemorrhage • IV access

  11. Isotonic crystalloids • NS and LR are hypo-oncotic, so they shift into extravascular space. • physiologic basis for the 3:1 ratio for isotonic crystalloid volume replacement: • for every amount of blood lost, three times that amount of isotonic crystalloid is required to store intravascular volume because, at best, about 30% of the infused fluid stays intravascular.

  12. Blood transfusion • RBCs most common • Indicated if no or minimal response to 2-3 liters of fluid administration • Hgb < 6: transfuse • Hgb > 10: hold transfusion • Hgb >6 but <10: clinical judgement

  13. Coloids • Higher oncotic pressure • No mortality benefit as compared to crystalloids • Much more expensive

  14. resources • Tintinalli, Ch. 26

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