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volume replacment follwing hemorhage control

oded private tangentcarrot at hotmail.com
Sat Oct 29 15:44:36 BST 2005


"Permissiove hypotension is for the patient with non-compressible bleeding"- 
well, that's preety clear,but I was intrested to hear about the approach to 
post operative fluid treatment from the same people practice "permissive 
hypotension", since they do have a diffrent theoretical (as I see it) 
approach to the whole concept of fluid resusscitation and it's golas. So,  
"give what you have" sounds rather odd to me- if "what I have" is LR/NS 
you're risking in blood dilution and interstitial edema, if "what I have" is 
colloids than it's just no good, and "if what I have" is packed RBC and 
other blood components, well we don't have too much of it so we don't just 
give it to everyone, don't we?

>From: Eitan Melamed <eitanme2000 at yahoo.com>
>Reply-To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
>To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
>Subject: Re: volume replacment follwing hemorhage control
>Date: Fri, 28 Oct 2005 17:47:54 -0700 (PDT)
>
>Oded,
>
>Permissive hypotension is for the patient with non-compressible bleeding, 
>before surgical control. For controlled hemorrhage, give what you have, 
>based on perfusion status. I think that fluid choice a minor issue in this 
>case. The standard in most places is still crystalloids (LR, NS). If the 
>patient continues to be tachycardic but well perfused- don't give fluids. 
>He might suffer pain and benefit from IV morphine.
>Please read the special suppliment to J Trauma, June 2003.   The ENTIRE  
>journal is on this subject
>
>Eitan Melamed
>
>oded private <tangentcarrot at hotmail.com> wrote:
>Hello trauma list
>
>This question is for those of you who practice permissive
>hypotension/hypotensive resusscitation.
>What do you consider to be the standart for fluid and blood product
>adminstration after hemorhage is under control given-
>1. the patient is hypotensive (SBP<100, let's say, and maybe coauglophatic)
>2. the patient is normotensive but continues to be tachycardic
>
>Oded, Army Medic and much more
>IDF School of Military Medicine
>
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