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Wed May 2 18:16:03 BST 2007

l am no surgeon but in in these kind of situations l always give
crystalloids because there's no blood product available and patient need
blood pressure to live,l agree that patient can benefit from permissive
hypotension but just how low is permissive? and another thing not
necessarily related to this case:if hemodinamicly stable patient has a
suspected hemopericardium should you give fluid bolus if ultrasound cannot
clearly show nor exclude diagnosis?
ante

2007/5/2, Robert F. Smith <rfsmithmd at comcast.net>:
>
> Dr. Mattox,
>
> I guess I meant in this EXACT scenario. Of course we all agreed the
> patient
> needs immediate surgical exposure and to have the heart delivered out of
> the
> pericardium. While that effort is being initiated, and since IVs are
> already
> in place, why not give a fluid bolus. I thought this was first line Rx of
> tamponade, especially since the pt. appears ready to arrest. Not to DELAY
> IN
> ANY WAY the needed life saving surgical intervention.
>
> Is there harm in providing more filling pressure at the same time the
> providers are getting set to open the chest?
>
> R. Smith
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org]
> On Behalf Of KMATTOX at aol.com
> Sent: Wednesday, May 02, 2007 10:49 AM
> To: trauma-list at trauma.org
> Subject: Re: s/w to box
>
>
> In a message dated 5/2/2007 5:47:26 A.M. Central Daylight Time,
> rfsmithmd at comcast.net writes:
>
> Dr.  Mattox, why do you say no to fluid bolus in this
> particular  scenario?
> Single stab wound to heart; pt. crashing with presumed  tamponade.
>
> R. Smith
>
>
>
> What this patient needs is an incision in the chest, either up and down or
> left anterolateral.   If the surgeon desires and is more comfortable  for
> exposure, then a clamshell is appropriate.    Pushing blood  and fluid are
> time
> wasting temporarizing efforts only and have their
> own  complications.    In
> my
> view, I see NO indication ever to give  crystalloid fluid boluses in the
> trauma
> patient.   That is an old  urban legend, and one that carries its own set
> of
>
> unfavorable  complications.    Blood and plasma boluses are a different
> thing,
> but it takes a while to get such products, and in the patient described,
> that
> time is too long.   CUT.
>
> k
>
>
>
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