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Emergency Fluid Therapy

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R
Rashidi Ahmad
Gesundheit & MedizinTechnologie
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Fluid Therapy in Emergency Care Dr. Rashidi Ahmad Medical Lecturer/emergentist School Of Medical Sciences USM Health Campus Kelantan 2 nd Regional Fluid Transfusion Workshop 10 February 2007
Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
“ The Neglected Disease of Modern Society” Trunkey, DD
Trauma Chain of survival Fluid therapy is a part of the factors…
Polytrauma? ,[object Object],Marius Keel et al. Pathophysiology of trauma. Injury (2005) 36, 691-71
O2 flux = [ C.O X Hb X SaO2 X k] + [ C.O X PaO2 x 0.003] Principle of fluid therapy in Emergency care
Shock ,[object Object],[object Object],Cumulative O2 debt overwhelms the physiologic reserve of CVS & RS to compensates = SHOCK Mohd Y Rady. Em. Med, 1996
Traumatic shock ,[object Object],[object Object],[object Object],[object Object]
Marius Keel, Omar Trentz. Pathophysiology of polytrauma. Injury (2005) 36, 691 - 709
Pseudo-shock
Fluid Balance Consequences in Early Shock ,[object Object],[object Object],[object Object],[object Object],[object Object]
Late shock ,[object Object],[object Object],[object Object],[object Object],[object Object]
Phases of Resuscitation in Trauma Care ,[object Object],[object Object],[object Object],[object Object]
Aim of volume resuscitation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Goals of Fluid therapy in hemorrhagic shock ,[object Object],[object Object],[object Object]
Fluid of choices ,[object Object],[object Object],[object Object],[object Object]
Options for fluid resuscitation ,[object Object],[object Object],[object Object],[object Object]
Optimal fluid resuscitation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Crystalloids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Crystalloid
Crystalloids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Colloids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Colloid (no capillary leakage)
Colloids versus crystalloids for fluid resuscitation in critically ill patients: ,[object Object],[object Object]
The crystalloid–colloid debate has evolved into a colloid-colloid debate
Ideal colloid National Research Council – USA (1963) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Gelatins ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Dextrans ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Albumin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Starches ,[object Object],[object Object],[object Object],[object Object]
Hetastarch (hydroxyethyl starch) ,[object Object],[object Object],[object Object]
Hetastarch evolutionary concept ,[object Object],[object Object]
HAES classification
Types of HES ,[object Object],[object Object],[object Object],[object Object],[object Object]
Advantages of HES ,[object Object],[object Object],[object Object],[object Object]
HES & allergic reactions Laxenaire MC et al. Anaphylactoid reactions to colloid plasma substitutes: incidence risk factors mechanisms. Annales Francais d’Anesthesie et Reanimation 1994;13:301–10 A French multicenter prospective study.
Disadvantages of HES ,[object Object],[object Object],[object Object]
Voluven ,[object Object],[object Object],[object Object],Anest Analg 2003;96:936 – 43 Anesthesiology, V 99, No 1, Jul 2003
Hypertonic saline Stackford SR. J Trauma 1998:44:50-8 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypertonic Saline
Velasco IT et al. Hyperosmotic NaCl and severe hemorrhagic shock. Am J Physiol 1980;239:H664-73 ,[object Object],[object Object]
Best evidence ,[object Object],[object Object],[object Object]
Best evidence ,[object Object],[object Object],[object Object]
Blood ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Blood ,[object Object],[object Object],[object Object],[object Object]
Alternative choices ,[object Object],[object Object],[object Object],[object Object]
Autologous blood salvage technique ,[object Object],[object Object],[object Object],[object Object]
Artificial hemoglobin ,[object Object],[object Object],[object Object],[object Object]
Hemoglobin based oxygen carrier HBOCs ,[object Object],[object Object],[object Object],[object Object]
HBOC- 201 ,[object Object],[object Object],[object Object]
Fluid resuscitation: WHEN & HOW MUCH? ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],Kowalenko T, Stern S, Dronen S, Wang X. Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic shock in a swine model. J Trauma 1992;33:349-53. Stern S, Dronen S, Birrer P, Wang X. Effect of blood pressure on hemorrhage volume and survival in a near- fatal hemorrhage model incorporating a vascular injury. Ann Emerg Med 1993;22:155-63.
Postulation ,[object Object],[object Object],[object Object],[object Object]
SBP threshold ,[object Object],[object Object],[object Object]
[object Object],[object Object],Hahn RG. The use of volume kinetics to optimize fluid therapy. J Trauma 2003;54:S155-8
The optimal volume of IV fluid administered is a balance between improving tissue oxygen delivery against increasing the blood loss by raising SBP MODS CLOTS Major controversy
Delayed fluid resuscitation in penetrating trauma ,[object Object],[object Object],[object Object],[object Object],[object Object]
Delayed fluid resuscitation in penetrating trauma ,[object Object],[object Object],[object Object]
Delayed fluid resuscitation in penetrating trauma ,[object Object],[object Object],[object Object],[object Object]
Regel et al, Acta Anaesthesiol.Scand., 1997 ,[object Object],[object Object],[object Object]
On going debate/uncertainty ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Timing of resuscitation ,[object Object],[object Object],[object Object],Pepe et al Emerg.Med Clin.North Am., 1998
Pre-hospital resuscitation Søreide & Deakin, Injury, 2005 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Blunt Trauma Søreide & Deakin, Injury, 2005 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TBI Søreide & Deakin, Injury, 2005 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Penetrating injury Søreide & Deakin, Injury, 2005 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Søreide & Deakin, Injury (2005) 36, 1001 - 1010 ,[object Object]
Rocha-e-Silva et al. CLINICS 60(2):159-172, 2005 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],Sepsis Crit Care Med 1992;20:864-74
Fluids in septic shock Marx et al. Int Care Med , 2002 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Marx et al. Int Care Med , 2002 Fluid requirements
Cardiac output Marx et al. Int Care Med , 2002
Mixed S v O 2 Marx et al. Int Care Med , 2002
Acid base Marx et al. Int Care Med , 2002
Fluids in septic shock Marx et al. Int Care Med , 2002 ,[object Object],[object Object],[object Object]
Sepsis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
End point of resuscitation ,[object Object],[object Object]
Prehospital care, Arrival to ED Stabilization of vital signs Relieve tissue hypoxia Admission in ICU Phase 1 Phase 2 Phase 3 End point of Resuscitation of Shock
RADY ET AL • RESUSCITATION IN THE ED. AMERICAN JOURNAL OF EMERGENCY MEDICINE • Volume 14, Number 2 • March 1996 . End point of Resuscitation of Shock
End point of Resuscitation
Davis , Shackford. Base deficit as a guide to volume resuscitation. J. trauma 1988. ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Abramson et al. Lactate clearance and survival following injury. J. Trauma . 1993
Bishop, Shoemaker & colleague J. Trauma 1995 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Bishop, Shoemaker & colleague J. Trauma 1995 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Conclusions ,[object Object],[object Object],[object Object]
THANK YOU

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Nasal fb
Nasal fbNasal fb
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Mild traumatic brain injuryMild traumatic brain injury
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Mannitol Vs Hypertonic Saline
Mannitol Vs Hypertonic SalineMannitol Vs Hypertonic Saline
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Shock TrialShock Trial
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Emergency Fluid Therapy

  • 1. Fluid Therapy in Emergency Care Dr. Rashidi Ahmad Medical Lecturer/emergentist School Of Medical Sciences USM Health Campus Kelantan 2 nd Regional Fluid Transfusion Workshop 10 February 2007
  • 2.
  • 3. “ The Neglected Disease of Modern Society” Trunkey, DD
  • 4. Trauma Chain of survival Fluid therapy is a part of the factors…
  • 5.
  • 6. O2 flux = [ C.O X Hb X SaO2 X k] + [ C.O X PaO2 x 0.003] Principle of fluid therapy in Emergency care
  • 7.
  • 8.
  • 9. Marius Keel, Omar Trentz. Pathophysiology of polytrauma. Injury (2005) 36, 691 - 709
  • 11.
  • 12.
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  • 17.
  • 18.
  • 19.
  • 21.
  • 22.
  • 23. Colloid (no capillary leakage)
  • 24.
  • 25. The crystalloid–colloid debate has evolved into a colloid-colloid debate
  • 26.
  • 27.
  • 28.  
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 35.
  • 36.
  • 37. HES & allergic reactions Laxenaire MC et al. Anaphylactoid reactions to colloid plasma substitutes: incidence risk factors mechanisms. Annales Francais d’Anesthesie et Reanimation 1994;13:301–10 A French multicenter prospective study.
  • 38.
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  • 50.
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  • 52.
  • 53.
  • 54.
  • 55.
  • 56.
  • 57. The optimal volume of IV fluid administered is a balance between improving tissue oxygen delivery against increasing the blood loss by raising SBP MODS CLOTS Major controversy
  • 58.
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  • 61.
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  • 63.
  • 64.
  • 65.
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  • 68.
  • 69.
  • 70.
  • 71.
  • 72. Marx et al. Int Care Med , 2002 Fluid requirements
  • 73. Cardiac output Marx et al. Int Care Med , 2002
  • 74. Mixed S v O 2 Marx et al. Int Care Med , 2002
  • 75. Acid base Marx et al. Int Care Med , 2002
  • 76.
  • 77.
  • 78.
  • 79. Prehospital care, Arrival to ED Stabilization of vital signs Relieve tissue hypoxia Admission in ICU Phase 1 Phase 2 Phase 3 End point of Resuscitation of Shock
  • 80. RADY ET AL • RESUSCITATION IN THE ED. AMERICAN JOURNAL OF EMERGENCY MEDICINE • Volume 14, Number 2 • March 1996 . End point of Resuscitation of Shock
  • 81. End point of Resuscitation
  • 82.
  • 83.
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  • 86.
  • 87.

Hinweis der Redaktion

  1. Tq 2 the organizing comitte 4 inviting me to deliver this topic. 4 me this topic is very relevant 4 us because trauma cases are common. RTA kills our youngsters. When it occurs it involves many victims – it leads to morbidity & mortality. Being as the common health problem and kills those productive people, yet nothing much has been done to improve the trauma management. If Donald Trunkey said trauma is the neglected disease of modern society, perhaps u can imagine how good we are managing the trauma cases. Prof. Donald trunkey is a trauma surgeon, working at oregon health science universiti, US. Is it true? Just simple questions, how many of u BTLS certified. How many of U ACLS certified? None. How about MTLS certified? BTC certified? Don’t ask whether I certified or not…