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Mon Oct 20 10:27:53 BST 2003

Dear Jenny,

RL contains approx. 60 mmol lactate per liter; the patient thus received
approx. 720 mmol lactate, total, over 6 hrs (equivalent to endogenous
lactate production due to exercise over this period). As the patients was
not severely injured, his liver should have metabolized that amount without
problems. I can see no mechanism by which the infused lactate could have
caused permanent liver damage requiring transplantation.

BTW, I never understood why people give RL to patients in shock - these
patients have enough lactate, anyway - why add any?

Best regards

Walter Mauritz

	-----Ursprüngliche Nachricht-----
	Von:	Jenny Kobersteen [mailto:vamaern at verizon.net]
	Gesendet am:	Freitag, 17. Oktober 2003 18:24
	An:	Trauma & Critical Care mailing list
	Betreff:	Lacate and Liver Damage

	I have come across a question that I cannot answer in the class that
I am
	taking.  A scenario was presented to me that was disturbing.  A car
went
	airborne and hit a tree 12 feet of the ground.  It took rescue 6
hours to
	extricate the individuals (3 alive, 1 dead).  One individual
received twelve
	(yes, 12)  liters of LR prior to extrication.  After evaluation, the
patient
	did not have any significant injuries, only superficial.  In the
long run,
	the patient needed a liver transplant.  I was told the reason was
because of
	the amount of Lactate was delivered to him.  I'm looking at some
literature
	regarding this, but it doesn't address anything like this.

	So my question,  If this is true,  what is the mechanism of lactate
and
	liver damage?  How much is too much?  I know that this much fluid is
bad.
	This scenario took place 10 years ago.  How much LR can cause you to
have
	adverse reactions with the liver?

	Thank you,

	Jenny Kobersteen, RN
	ALS Coordinator
	George Washington University
	Emergency Health Services

	-----Original Message-----
	From: trauma-list-bounces at trauma.org
	[mailto:trauma-list-bounces at trauma.org]On Behalf Of Jeff Brosius
	Sent: Thursday, October 16, 2003 10:49 PM
	To: Trauma & Critical Care mailing list
	Subject: Re: Re; helicopter transport

	At 06:20 AM 10/16/2003, you wrote:
	>What are the helicopter transport guidelines for a well populated
inner
	city.

	I can not think of any reason to call a helicopter to transport if
I'm in a
	city such as Detroit.

	When I worked in Atlanta, our rule was 45 minutes... If we could get
to the
	trauma center in 45 minutes or less, we didn't bother with the bird.
And
	since we could almost ALWAYS get to the trauma center in that time
frame,
	we very seldom called the helo.

	In 6 years in Atlanta, I know of ONE case where a crew called the
	helo.  MVC with three critical patients, and bad rush hour traffic
(in
	Atlanta, "bad" rush hour traffic means 6 lanes of interstate highway
	sitting still... for an hour.)  Ground EMS took two patients, helo
took
	one.  And true to form, they overflew the level 1 for a level 2
(though the
	increase in flight time was minimal... perhaps 30 seconds?)

	There is an additional safety factor to consider:  Most urban EMS
and Fire
	crews do not get much experience in establishing a safe landing
zone, there
	are more wires/poles, and greater hazards to deal with.  Rural
responders
	do much better at this... large, open farm fields, fewer power
lines, etc.

	Short version:  Don't see a need to call a helo in a city.

	Best,

	Jeff Brosius
	Paramedic, etc.
	Denver, CO
	"...forbear to deliver them that
	are drawn unto death." Proverbs 24:11 (NIV)
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AW: Lacate and Liver Damage