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Sun Oct 15 19:12:46 BST 2006

l would just ask ATLS instructors and others willing to answer on
permisssive hypotension in patients in which you can't rule out possibility
of percardial effusion(due to let say pneumothorax which inhibits sonogram
to visualize pericardium.and if petient has suspected abdominal bleeding and
is stable so you are observing him/her. would you proceed with fluid
resuscitation to see early sings of tamponade if there is such or keep pt
hypotensive due to susp abd bleeding.
ante

2006/10/15, Krin135 at aol.com <Krin135 at aol.com>:
>
> I'm reviewing my ATLS for a class at the end of the month, so this
> will  come
> in several parts, as I run into things.
>
> Chapter 1, Section II, B Inhospital Phase (page 12): "Warmed Intravenous
> crystalloid solutions (eg, Ringer's Lactate)....
>
> Change to "Low volumes of Normal Saline"-
>
> Rational: there have been a number of studies out over the last several
> years calling into question the utility of adding additional lactate to an
> already stressed, possibly lactate overloaded, system. This would be
> especially
> true if the patient was a diabetic already on one of the lactate system
> blocking
> agents (eg. Metformin). In addition, many studies have shown the value of
> low
> volume resuscitation in preventing "Shock Lung" or ARDS, and in preventing
> additional internal bleeding by not raising the systolic blood pressure to
> the
> point of 'popping the clot' prior to obtaining definite bleeding control
> by
> either direct or radiologic intervention methods.
>
> Same chapter and section (page 13): "Most prominent among these
> diseases  are
> hepatitis and the acquired immune deficiency syndrome (AIDS)."
>
> Change to specifically add Hepatitis B and C and change the other to refer
> to HIV infection.
>
> Rational: Hepatitis B is readily preventable by immunization, Hepatitis
> C  is
> much more common than previously thought (up to 2% of the population in
> some
> areas) and NOT immunizable, and while we rarely see full blown
> AIDS  anymore,
> at least here in North America, the term 'HIV infection' is
> more  inclusive.
>
>
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