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Fluid Resuscitation in Trauma

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Presentation on theme: "Fluid Resuscitation in Trauma"— Presentation transcript:

1 Fluid Resuscitation in Trauma
By/ Hany Maher References: Manual of Advanced Trauma lifesupport course; 5:45-52, 2010. Emergency war surgery; 6:1-10, 2008 Protocol of management of critical cases;1-30,2008

2 Objectives Approach to a traumatized patient ( revision)
When to give fluid What is the appropriate type of fluid to be given How much to be administrated Special situations

3 Case Report (main items)
Female patient 45 years old Presented to the ER post RTA 1 hr ago Medically free by history S & S: HR 120b/min, Bl pr 80/40 mmHg ,Sweating, drowsy Rt leg pain and disability Rt hypochondrial pain, contusions & difficult breathing After full survey: # Rt Tibia #Rt 12 Rib 1hr later , despite Fluid administration: worsened vital signs DLC

4 What is the cause of Shock in this patient ?
-Hypovolemic -Distributive( neurogenic, anaphilactic..) -Cardiogenic -Obstructive

5 How can we differentiate ?
-Insert a central line -Do further investigations -Intubate the patient -Give vasopressors

6 If in addition: Exaggerated pain in Rt hypochondrium
Key: from the Pelvi-abd U/S… Creat. stat

7 This was the CT abd with contrast !!!

8 1- Approach to Trauma patient
Preparation: notification, prepare place Triage: Color code 1ry Survey: A B C D E Resuscitation: Oxygen 2 wide bore canulae (16G) Fluid Resuscitation Adjuncts: Preg test-U. cath

9 6. 2ry Survey: Hist. (AMPLE)& Head to toe exam 7
6. 2ry Survey: Hist.(AMPLE)& Head to toe exam 7. Adjuncts: Special survey 8. Post resusc. reeval.: S&S-UOP 9. Definitive care

10 2- Shock in Trauma ptn. Inadequate tissue perfusion…
Types: Hypovolemic : the most common Destributive : neurogenic, vasogenic Obstuctive : Tamponade Cardiogenic: Acute MI

11 Apnea Aortic/ Heart rupture Epidural/ Subdural hematoma Cardiac tamponade Haemo/ Pneumothorax Intra-abdominal bleeding (Spleen, Liver) Pelvic fractures Multiple injuries with significant blood loss Sepsis Multiple organ failure

12 3- Hypovolemic Shock (Hemorrhagic)

13 Hypovolemic Shock (Hemorrhagic)
Take Care : Tachycardia is not reliable Hypotension is late(30-40%) (Occult Hypoperfusion Syndrome) (Symp. Compensate till 30% in minor T. Then: + Cardiac C fibers---cause – VMC ↓Bl. Pr) So: ABG Base deficit>2 Lact. Acidosis>2.5

14 Till Now we have discussed:
Approach to trauma ptn Types of Shock in Trauma ptn Hypovolemic shock

15 4- Management of Shock in trauma ptn.
A)General Rules: -Warming: Hypothermia ↓BL pr, HR, RR -Best Resuscit. Is in the Golden hr - We aim to restore tissue Oxygenation not simply Bl pr.

16 B) 1ry Survey and Resuscitation
A B C D E Consider Hypovolemic shock untill proved otherwise Stop or Decrease Bleeding: Pr points: Hand wrist Arm-----axilla Forearm------inner upper arm Thigh-----below the groin Leg----behind the knee 2 wide Bore Canulae (16G) Interosseous: <6 years, Pr., Tibial tuberosity , Epidural needle Central Line: not in the protocol, If needed---Femoral

17 Type ? Amount ? Limit ?

18 1-2L warmed lactated ringer ,20ml/kg in child
(no Dextrose 5%, no Vasopressors) Evaluation of degree of Blood loss: Difficult!! Minimal Trauma( 30%)----Syst 70 mmHg (1-2L) (permessive hypot.) Blood loss>30%-----Colloids and/or Packed RBCs(conservative strategy:Hb7,Hct Syst 110 mmHg ( 3-4 L) (If + head injury-----Syst 90 mmHg)

19 C) 2ry Survey Hist & Exam( head to toe)
Analgesia, Antibiotic, tetanus toxoid, antiemetic ( not IM) Patient may be : Responder(regain Conc., palpable radial art., SBP>90, MAP>60) Transient responder: Damage control surgery Non responder: Urgent surgery


21 1- Haemostatic Resuscitation
Special Remarks: 1- Haemostatic Resuscitation Permessive hypot. Early use of Blood Transf. But---remember the adv. of reduced Hct on the viscosity and flow of the blood ABO cross matching (10 min)-----O negative 1 RBCs : 1 FFP + PLT (1 pack/ 10 kg if < or < in major trauma) Procoagulant therapy: Novoseven mic/Kg over 2 hrs / 2 hrs Proth Complex Conc.(2,7,8,9,10,prot C)

22 2- Massive Blood Loss Def.: loss of one Bl volume over 24 hr, or
Loss of 50% of Bl volume over 3 hrs, or Loss of 150 ml per minute 3- Massive Blood Transfusion Def: replacement of the whole Blood voluume in <24 hrs Acute administration of > 0.5 Blood volume/hr

23 Acidosis  Coagulopathy
Hemorrhage Massive transfusion Hypothermia Acidosis  Coagulopathy


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