Fluid and blood resuscitation in abdominal trauma

“ FLUID AND BLOOD RESUSCITATION IN ABDOMINAL TRAUMA: IMPORTANT TIPS IN CLINICAL PRACTICE FOR SURGEONS ” Dr. T.C. Kriplani Professor & Head Department of Anaesthesiology NSCB Medical College JABALPUR (M.P.)

American College of Surgeons Classes of Acute Hemorrhage Factors I II III IV Blood loss <15% (<750ml) 15-30% (750-1500ml) 30-40% (1500-2000ml) >40% (>2000ml) Pulse >100 >100 >120 >140 B.P. Normal Normal ↓ ↓↓ Pulse pressure N or ↓ ↓ ↓↓ ↓↓ Capillary refill <2s 2-3s 3-4s >5s Resp. rate 14-20 20-30 30-40 >40 Urine output ml/hr 30 or more 20-30 5-10 Negligible Mental status Slightly anxious Mildly anxious Anxious & confused Confused Lethargic

Response to blood loss ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Asses the loss quickly on clinical grounds ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

If the loss is 1500-2000ml (30-40%) ,[object Object],[object Object],[object Object],[object Object]

If the loss is >2000ml(40%) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Which crystalloid is better? ,[object Object],[object Object],Crystalloid Osmolarity P H Remarks Recommendations Dextrose 5% 252 4.5 Hypotonic, glucose taken up by cells & water produces oedema. Low PH, ↑blood sugar-brain ischemia. ↑ CO2 production, ↑ lact. Production NEVER BE USED Saline 0.9% 308 (Na 154, Cl 154meq/L) 5.7 Low PH. Hyperchloraemic acidosis is produced. NOT IDEAL Saline 7.5% 2567 (Na 1283, Cl 1283) 5.7 Vol. Exp(250ml->1235ml) Interstitial & cellular dehydration. Rapid rate dangerous. NOT DESIRED Lactated Ringer’s solution 273 (Na 130, Cl 109, K 4, Ca 3, lactate 28) 6.4 Osmolarity near blood Lactate act as buffer. Converted to bicarbonate BETTER Normosol 295 (Na 140, Cl 98, K 5, Acetate 27, Mg 3) 7.4 Mg. can counteract compensatory vasoconstriction NOT DESIRED

Which colloid is better? ,[object Object],[object Object],[object Object],[object Object],[object Object],Albumin Oncotic pressure mm of Hg Vol. expansions Half life 5% 20 70-100% 16-24 hrs 20% 70 300% 16-24 hrs 25% 100 500% 16-24 hrs

Synthetic colloids ,[object Object],[object Object],[object Object]

GELATINS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

DEXTRANS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

DEXTRAN 40 (10%) (Lomodex, Plasmex-40) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

STARCH (Hydroxy Ethyl Starch) H.E.S. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Physiochemical properties of different H.E.S. preparations HES 70/.5 HES 130/.4 HES 200/.5 HES 200/.5 HES 450/.7 Concentration 6% 6% 6% 10% 10% Oncotic pressure mm. of Hg 30-36 36 30-37 55-60 25-30 Volume expansion 100% 100% 100% 130% 100% Half life (hrs) 1-2 2-3 3-4 3-4 5-6 Maximum dose ml/kg 33 50 33 33 20 Effect on hemostasis 0 Negligible + ++ +++

H.E.S.(Contd.) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Indications of Blood Transfusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

MOST IMPORTANT IS CLINICAL MONITORING ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CLINICAL MONITORING(Contd.) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

BEWARE OF LETHAL TRIAD ,[object Object],[object Object],[object Object]

Fluid and blood resuscitation in abdominal trauma

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Fluid and blood resuscitation in abdominal trauma