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volume replacment follwing hemorhage control

Eitan Melamed eitanme2000 at yahoo.com
Sat Oct 29 21:25:09 BST 2005


Your question is not about hypotensive resuscitation. Following surgical hemostasis, one of the main objectives is to RAISE blood pressure (which is BAD for uncontolled hemorrahge-again, a DIFFERENT scenario), but more importantly preserve perfusion. This raise in BP may transitory (esp with crystalloids), thus new fluids must be given if  BP elevation is the objective. Blood dilution and interstitial edema is a concern for the overly agressive fluid hyperresuscitation, but for a young previously healthy guy with normal kidneys who gets a drip of 1-2 L of LR, thats not much of an issue...  
PRBCs are a poor choice for volume expansion, along with many other problems they carry.

oded private <tangentcarrot at hotmail.com> wrote:
"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 
>Reply-To: Trauma & Critical Care mailing list 
>To: Trauma & Critical Care mailing list 
>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 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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