PRE-HOSPITAL PHASE ;DILEMMA; Definitive Hmge control –No Inadequate Resus. -Mortality Full Resus. -Hmge
PREHOSPITAL PHASE Two schools of thought Scoop & Run, Target, ;palpable pulse; Stay & Play, Necessitate, control bleeding ( Thoracotomy,Laparotomy)
PREHOSPITAL PHASE Resuscitation Fluid 1 ;Colloid vs crystalloids; 2 ;Iso-osmolar/oncotic vs hyper-osmolar/oncotic; 3 ;Saline vs Lactated Ringer;
CONSENSUS VIEW Emergency Medicine Journal 2002;19;494-498 Revell M,Porter K,Greaves I.
FULL TEXT ;Fluids should not be administered to a trauma patient before haemorrhage control if radial pulse can be felt,if not,give boluses of fluid challenge(250 mls) till the pulse is palpable.Now Suspend fluid therapy & monitor the situation.;
Reference Bickel WH, Wall MJ, Jr., Pepe PE,et al. Immediate versus delayed resuscitation for hypotensive patients with penetrating torso injuries.New England Journal of Medicine 1994;331: 1105-1109.
TABLE VARIABLEIMMEDIATE R 309 DELAYED R 289 Before arrival at H Ringer lact. Ml 870+- 92+- TRAUMA CENTRE Ringer lact; Ml 1608+- 283+- Packed red cells 133+-11+- Operating room Ringer lact;Ml 6772+- 6529+- Packe3d red cells 1942+- 1713+- FFP ;Ml 357+- 307+- Rate of I/O infusion ml/min 117+- 91+-
2- HOSPITAL PHASE :Continuum from field: EXPERIENCE + EQUIPMENT ;The key is the time to control surgical haemorrhage;
2-HOSPITAL PHASE Best available evidence based approach to furthure resuscitation in the same way as any other critically ill patient; AIM; Restore full circulation and optimal perfusion of all tissues guided by monitoring
RECOMMENDATIONS 0.9% SALINE, Resuscitation fluid of choice both in field & Hospital untill head injury is ruled out Lactated RINGER, For hydration in non head injured COLLOIDS, For volume resuscitation
SUCCESSFUL RESUSCITATION REQUIRES:- ;early restoration of Heart-Lung- Brain circulation to avoid immediate death; 50% BV replacement required to restore a viable Heart-Lung-Brain circulation in non anaesthetised,non sedated patient 100% BV replacement to reperfuse all organs,especialy Splechnic bed
HOSPITAL PHASE - HDU/ICU Specialised care + Advanced monitoring + Multi-organ support
CONCLUSION 1,Restore pulse with boluses of Saline 2,Transfer to hospital,control bleeding,exclude head injury,then Ringer lactate for hydration and synthetic colloids for volume resuscitation. 3,Blood/products—early 4,Saline-choice for early Resus