د/عاصم محرم Blood product transfusion & Principles of Fluid Therapy المحاضرة التي قدمت يوم الثلاثاء 8 ابريل 2014 في دار الحكمة بالقاهرة من فعاليات مشروع اعداد طبيب حكيم ناجح بالتعاون مع معتمد باتحاد الاطباء العرب و ضمن موديول الطوارئ و التخدير و العناية المركزة

1. Fluid Resuscitation
Assem Adel Moharram
Lecturer of Anesthesia & Intensive Care
Ain Shams University

3. C...Circulation

4. Body Water

6. Hypovolemic Shock
 Trauma:
◦ Solid organ injury
◦ Pulmonary parenchymal
injury
◦ Myocardial
laceration/rupture
◦ Vascular injury
◦ Retroperitoneal
hemorrhage
◦ Fractures
◦ Lacerations
◦ Epistaxis
◦ Burns
 GI Tract:
◦ Esophageal varices
◦ Ulcer disease
◦ Gastritis/esophagitis
◦ Mallory-Weiss tear
◦ Malignancies
◦ Vascular lesions
◦ Inflammatory bowel
disease
◦ Ischemic bowel disease
◦ Infectious GI disease
◦ Pancreatitis
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7. Hypovolemic Shock
 Vascular:
◦ Aneurysms
◦ Dissections
◦ AV malformations
 Reproductive Tract:
◦ Vaginal bleeding
 Malignancies
 Miscarriage
 Metrorrhagia
 Retained products of
conception
 Placenta previa
◦ Ectopic Pregnancy
◦ Ruptured ovarian
cyst
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8. Some tips for
Resuscitation….

9. Choice of fluids
 Crystalloids
 Colloids
 Blood products
◦ Whole blood
◦ PRBC
◦ FFP
◦ Platelets

10. Crystalloids
…
 Normal saline
 Ringer’s
 Lactated Ringer’s
 Ringer Acetate
 …
Colloids…
Hestril
Voluven
Albumin
Dextran
…

11. Advantages
Crystalloids…
 Inexpensive.
 Use for maintenance
fluid and initial
resuscitations
 Promote U.O.P
 Intravascular half-life
20-30 minutes.
Colloids…
 ↑ plasma volume
 Less peripheral
oedema
 Smaller volumes for
resuscitation
 Intravascular half-life
3-6 hours.

12. Disadvantages
Crystalloids…
 Dilute plasma protien
 Peripheral edema.
 pulmonary edema.
Colloids…
 Expensive.
 Coagulopathy.
 Anaphylactic
reaction.

13. Whole blood:
 Hct 40%.
 Increase haemoglobin about 0.5 g/dl.
 Use: primarily in haemorrhagic shock.
Packed red blood cells (PRBCs):
 Hct 60-75%.
 Increase haemoglobin about 1 g/dl.
 Volume 250–350 ml.

14. Fresh frozen plasma
(FFP):
 Contains all
coagulation
factors with no
platelets.
 Use: Reversal of
warfarin
effects, coagulo
pathy &

15. Platelets:
 Use: Thrombocytopaenia
and abnormal platelets
function.

16. Cryoprecipitate:
 Use: Treatment
of von
Willebrand
disease &
fibrinogen
deficits.

17. Wait……Please don’t forget

18. Risks of Blood products
transfusion
1. Transmission of infection.
2. Citrate toxicity
3. Acid-base change.
4. Decrease 2,3 –DPG.
5. Hyperkalaemia.
6. Dilutional coagulopathy.
7. Volume overload.
8. Hypothermia.

19. Amount of Fluids for
Resuscitation..
EBV x (Hi - Hf)
Hi
= ABL
Hi = initial Hct
Hf = final lowest acceptable Hct
Allowable Blood Loss (ABL)*

20. Estimated blood volume
Age Blood volume
Premature Neonates 95 mL/kg
Full Term Neonates 85 mL/kg
Infants 80 mL/kg
Adult Men 75 mL/kg
Adult Women 65 mL/kg

21. E.g.
 70 Kg male patient , Hi 40, Hf 30
 EBV=75x70=5250
 ABL= 5250x(40-30)/40=5250x ¼=
1312 ml

22. Amount of Fluids for
Resuscitation..
Crystalloids…
3-4 times
N.B…never D5

23. Colloids
1 : 1

24. That means you need a…

25. Question 1
 30 years old
healthy male
 Motor car accident
 Loss of one litre
blood in 30 min
due to vascular
injury
 Now , bleeding is
controlled
 Bp 90/50 ,pulse
100
What type of fluid..?
 Whole blood
 Packed RBCs
 FFP
 Crystalloids
 Colloids

26. Question 2
 70 years old
patient
 Ischemic heart ds
 On anticoagulant
(Marevan) for AF.
 Severe epistaxis
 Lost 1 litre of blood
 BP 90/50 ,pulse
100
What type of fluid..?
 Whole blood
 Packed RBCs
 FFP
 Crystalloids
 Colloids

27. What about an
extra
600 ml
fresh
blood,
warm,zero% infection,
Full of coagulation factors
Full of platelets.
and

28. Leg Elevation….

29. Routes for Resuscitation…
 Central line..
versus
 Peripheral Venous cannula..

30. Flow equation is the key..!!

31. 15-20 cm 5-6 cm

32. Queen of the day…

33. Cannula…!!!

35. The difference is….

36. .

37. Preparation….5 Ps

39. Proper position…
Patient Doctor

40. Tourniquet ..

41. Sterilization..

42. Knowledge..

43. Fixation..

46. Craniotomy