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

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Fluid resuscitation trauma patient l.jpg

FLUID RESUSCITATION TRAUMA PATIENT

Author;

Prof.MEHDI HASAN MUMTAZ

Consultant Intensivist/ Anaesthetist

Christie Hospital,Manchester,U.K.


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FLUID THERAPY

  • Questions

    1,Does the pt.need fluids ?

    2,How much he/she needs ?

    3,What type of fluid is

    needed ?


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STATUS OF HYDRATION

  • Intravascular Haemodynamics

  • Interstitial Skin fold

  • Intracellular thirst,confusion,coma,death

    confusion,convulsion,coma,death


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FLUID RESUSCITATION

  • 1. Prehospital phase

  • 2. Hospital phase

    Resuscitative ( A&E)

    Operative (OR)

    Critical care (HDU,ICU)


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PRE-HOSPITAL PHASE

;DILEMMA;

Definitive Hmge control –No

Inadequate Resus. -Mortality

Full Resus. -Hmge


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PREHOSPITAL PHASE

  • Two schools of thought

    Scoop & Run,

    Target, ;palpable pulse;

    Stay & Play,

    Necessitate, control bleeding

    (Thoracotomy,Laparotomy)


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PREHOSPITAL PHASE

  • Resuscitation Fluid

    1 ;Colloid vs crystalloids;

    2 ;Iso-osmolar/oncotic

    vs

    hyper-osmolar/oncotic;

    3 ;Saline vs Lactated Ringer;


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CONSENSUS VIEW

Emergency Medicine Journal

2002;19;494-498

Revell M,Porter K,Greaves I.


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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.;


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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.


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TABLE


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TABLE


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2- HOSPITAL PHASE

  • :Continuum from field:

    EXPERIENCE

    +

    EQUIPMENT

    ;The key is the time to control surgical haemorrhage;


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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


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TYPES FLUIDS

  • COLLOIDS:-

    Efficient

    No edema

    Expensive

    Affect Co-agulation


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TYPES OF FLUIDS

  • CRYSTALLOIDS:-

    Less expensive/unit

    Less efficient

    Cause oedema

    eg,Abdominal

    compartment syndrome


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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


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TYPES OF FLUIDS

  • BLOOD & BLOOD PRODUCTS

    Expensive

    Availability

    O2 Delivery

    Coagulopathy correction

    Target > 10G /dl


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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


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TYPES OF FLUIDS

HYPERTONIC & HYPER ONCOTIC

SOLUTIONS

PERFLUROCARBONS & STROMA FREE HAEMOGLOBIN SOLUTIONS

; ExpermentAL PRODUCTS;


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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


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HOSPITAL PHASE - HDU/ICU

Specialised care

+

Advanced monitoring

+

Multi-organ support


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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


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