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Mon Aug 6 03:21:25 BST 2007

In a message dated 8/5/2007 9:12:31 P.M. Central Daylight Time, ih7 at msn.com  
writes:

What I  don't understand is why crystalloids help - they do not increase 
oxygen  delivery meaningfully..
but they keep the BP and CO, - is that useful for  the body ?? Why ?

What if we just keep up the BP and not the CO - by  using pressors ??  (now I 
am questioning the dogma).
Would patients  become more acidotic and have low SvO2 more than with 
crystalloids  ?

The BIG fallacy here is that we continue to assume that CO and BP are our  
objective of resuscitation.   WRONG.   Whether it be brain,  kidney, gut, or big 
toe preservation, it is perfusion and oxygen extraction that  is essential, 
with variables of temperature, pH, etc. altering the  exchange.     That is why 
NIR would be much better than the  BP cuff.     Whether it is MAST, drugs, 
crystalloids, or  position, any attempt to resuscitate based on BP as an end 
point simply is  living in the 1960s and not the 21st century.      Get  your 
head out of the past and into current thinking.   You need to go  no further than 
Karim Brohi's trauma.org pages to get an excellent review of  this subject.  

k

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Why are crystalloids better > pressors ?= NEITHER