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Sat Nov 27 21:32:12 GMT 2004

In a message dated 11/27/2004 2:40:50 PM Eastern Standard Time,  
c_brault at yahoo.com writes:

Stop  being so dogmatic
Their are exceptions to your dry resus approach
this  is one of them
This is a single source
CONTROLD/ABLE BLEED
Correcting  the hypotension & vasovagal reaction
(No not over resuscitating)
Is  totaly appropriate for the Pts well being

Charles--
In fact,.a very simple, basic and logical point is being missed by you and  
some other respondents--there is nothing immediately life threatening of a BP 
of  70--the patient was awake and mentating, no?  This is why IV's at this  
point--or at least infusing IV fluids--is liable to make matters worse--will  
increase bleeding, not make things better.  Leave things as they are and  get to 
a center to definitively care for the problem.  Not one person yet  has 
indicated what the treatment of bleeding is--it is NOT IV fluids, pulse  ox's, etc!
The treatment of bleeding is....STOP the BLEEDING!  Can anything be  simpler? 
 And in this case, the bleeding is eminently simple to stop.   Even the 
original poster did not describe what they did for the bleeding, so  indicative of 
the flawed thinking pervading cases like this that I see every  week--a simple 
finger over the radial and ulnar arteries at the severed  wrist--not a 
pressure dressing that obviously was not working if it was soaked  with blood--or a 
tourniquet--would be all the "treatment" neded--then ship to a  center where 
the arteries could be ligated or repaired--depending on the  salvagability of 
the hand.  At a BP of 70, with bleeding stopped, the  patient will be fine.  
After the bleeding is stopped, replacement of what  was lost should be carried 
out, but not very much replacement--if any at all--  will be necessary.  With 
the bleeding stopped, the body can compensate  quite nicely and recoup most 
volume loss on itw own (look how well the patient  was compensating while still 
bleeding!)...the best thing to do in cases like  this is to first....take your 
own pulse!  Then calm down, be sensible, and  things will be fine--they 
certainly couldn't be simpler!
ERF

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