FLUID AND BLOOD RESUSCITATION

FLUID AND BLOOD RESUSCITATIONPRESENTER ASHRAY . V

BODY FLUID COMPARTMENTSTotal body water content = 60% of total body weight.Intracellular Fluid : 2/3 (40%)of TBWExtracellular Fluid: 1 /3 (20%)of TBWInterstitial Fluid : 3/4 (15%)of extracellular waterIntravascular Fluid [plasma]: 1/4 (5%)of extracellular water.

CAUSES OF HYPOVOLEMIA :Hemorrhagic hypovolemia Pulmonary parenchymal trauma Pulmonary vascular injury Intercostal vascular injury Aortic disruption Massive hemoptysis Abdomen/pelvis/retroperitoneum Solid-organ injuries (liver, spleen, kidney) Vascular (trauma, aneurysmal rupture) GI hemorrhage (esophageal varices, ulcers, vascular anomalies, etc.) Gynecologic disorders (ruptured ectopic pregnancy, peripartum hemorrhage, abnormal uterine bleeding, ovarian cyst rupture, etc.) Orthopedic Pelvic fracture Large bone fractures Multiple fractures Major vascular injuries Large soft tissue injuries

Nonhemorrhagic hypovolemia GI disorders: vomiting, diarrhea, ascites Burns Environmental exposure or neglectRenal salt wasting

Aim of Fluid resuscitation Early, complete restoration of tissue oxygenation. Minimal biochemical disturbance Preservation of renal function Avoidance of transfusion complications.

First Priority: Restore volumeSecond Priority: Restore blood - oxygen carrying capacityThird Priority: Normalize coagulation status

FLUID RESUSCITATION

How to know that the patient has Hypovolemic Shock?The patient has the following sings and symptoms:1- Anxiety or agitation 2- Cool, Pale skin3- Confusion 4- Decreased or no urine output5- Rapid breathing 6- Disturbed consciousness7- Low blood pressure 8- Low body temperature9- Rapid pulse, often weak and thready

Composition of Different Fluids

SolutionsVolumesNa+K+Ca2+Mg2+Cl-HCO3-DextrosemOsm/LECF1424510327280-310Lactated Ringers13043109282730.9% NaCl1541543080.45% NaCl7777154D5WD5/0.45% NaCl7777504063% NaCl51351310266% Hetastarch5001541543105% Albumin250,500130-160