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Wed Jun 6 12:20:34 BST 2007

Steve

I don't see these as contradictory.  The point about permissive hypotension
strategies is that they should be used only for patients who are actively
bleeding, and in this group fluid therapy will not successfully restore
tissue perfusion, and will worsen the success rates of surgery and other
attempts and haemorrhage control.

As you say, the time to haemorrhage control must be short, as bad things are
happening while patients are hypoperfused.  At present, there's not much we
can do about this though.

Karim

On 05/06/07, walkersteve at bigpond.com <walkersteve at bigpond.com> wrote:
>
> Congratulations Karim on a fascinating article (and good to see you
> briefly in London at BAEM a few weeks ago).
>
> Interesting trying to integrate this with minimum volume resus stuff
> a) IV fluids causes increased hydrostatic forces, dilutional coagulopathy
> etc etc, leading to increased bleeding and increased mortality
> b) no IV fluids maintains shock, promotes coagulopathy, increased
> bleeding, increased mortality etc
>
> Perhaps this is the underlying explanation why prehospital interventions
> in general seem not to improve outcomes - ie there is only downside whatever
> you do.
>
> To me, this article helps justify the concept that the key to survival
> must be control of hemorrhage (by whatever means). Without this, shock and
> treatment of shock are both bad.
>
> Cheers
>
> Steve
>
>
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