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FLUID RESUSCITATION TRAUMA PATIENT

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

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  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

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