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volume replacment follwing hemorhage control

oded private tangentcarrot at hotmail.com
Sat Oct 29 22:14:48 BST 2005


I never said my question was ABOUT "hypotensive resuscitation", but that I 
was looking for an answer to it from those who practice it.

>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: Sat, 29 Oct 2005 13:25:09 -0700 (PDT)
>
>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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