Update in Fluid Rescusitation

8/17/2019 Update in Fluid Rescusitation

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UPDATE IN FLUIDRESCUSITATION

IN CORRELATION WITH INITIAL RESUSCITATION IN COMBATSETTINGS

31 Augst-1 Sept 200

W!"#$ %!"&!'()!"'*!W!"#$ %!"&!'()!"'*!

Dep!"t+e&t $, Su"ge". H!s!& S!'(#(& H$sp(t!/Dep!"t+e&t $, Su"ge". H!s!& S!'(#(& H$sp(t!/

U&(e"s(t $, P!'*!'*!"!&U&(e"s(t $, P!'*!'*!"!&B!&'u&gB!&'u&g


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A PROFILE OF COMBAT INUR A PROFILE OF COMBAT INUR

Champion HR et al : J Trauma 2003, 54 : S13-S19

Mechanim o! "oun#in$ Site o! %rimar& 'n(ur&


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Champion HR et al : J Trauma 2003, 54 :

A PROFILE OF COMBAT INUR A PROFILE OF COMBAT INUR

Site o! )atal 'n(ur&

Mechanim o! #eathin $roun# com*at


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ALGORITHM FOR THE INITIAL RESUSCITATIONOF COMBAT CASUALTIES

R)ee P. %$ust$! E A/!+ HB4 T"!u+!. 2003.56 557


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INITIAL FLUID RESUSCITATION ININITIAL FLUID RESUSCITATION IN

COMBAT SETTINGSCOMBAT SETTINGS

14 Re'u8e t)e e!8u!t($& t(+e

24 C$&t"$//e' 9/ee'(&g !&' :u(' (&,us($& t$ st!9(/(;e)e+$'&!+(8

34 I& u&8$&t"$//e' )e+$"")!g(8 s)$8#. !gg"ess(e :u('"esus8(t!t($& (s p"$)(9(te' +! (&'u8e "e-9/ee'(&g !&'

+$"t!/(t64 SCOOP AND RUN<

W)e& est(+!te' e!8u!t($& t(+e = 1 )$u". (++e'(!tee!8u!t($& !,te" !(">! 9"e!t)(&g )!e 9ee& se8u"e'.!&' I? /(&e (s (&st(tute' $& t)e >! t$ t)e su"g(8!/ u&(t

54 HPOTENSI?E RESUSCITATIONW)e& e!8u!t($& t(+e @1 )$u". 8$//$('s s)$u/' 9e !''e't$ 8"st!//$('s. 9ut t)e "!te $, (&,us($& s)$u/' 9e /(+(te'(& u&8$&t"$//e' )e+$"")!g(8 s)$8# t$ p"ee&t "e-9/ee'(&g

+ran MJ Trauma, 2003,54 S39-S42


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COMBAT CASUALTCOMBAT CASUALT

RESUSCITATIONRESUSCITATION

CURRENT CONCEPTSCURRENT CONCEPTS

1414L(+(te' $" s+!// $/u+eL(+(te' $" s+!// $/u+e

"esus8(t!t($&"esus8(t!t($&

2424Pe"+(ss(e )p$te&s($&Pe"+(ss(e )p$te&s($&

3434 I&t"!$sse$us (&,us($& IOI&t"!$sse$us (&,us($& IO


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SMALL-?OLUME RESUSCITATIONSMALL-?OLUME RESUSCITATION

IN HPOTENSI?E COMBATIN HPOTENSI?E COMBAT

CASUALT CASUALT

• T$ 8$+pe&s!te ,$" t)e /$g(st(8T$ 8$+pe&s!te ,$" t)e /$g(st(8

p"$9/e+sp"$9/e+s• HSD< Hpe"t$&(8 S!/(&e Det"!& HSD< Hpe"t$&(8 S!/(&e Det"!&

.5 N!C/ Det"!&-0.5 N!C/ Det"!&-0

• S(&g/e '$se. s+!//-$/u+e. (&S(&g/e '$se. s+!//-$/u+e. (&s)$"t t(+e 10-20 +(&utess)$"t t(+e 10-20 +(&utes

• I&t"!$sse$us "$uteI&t"!$sse$us "$ute


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Ma(alah .e!en#er 3 Mei 200/


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Commando Vol II Edisi No.6, 2006


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Ma(alah .e!en#er 3 Mei 200/


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PHSIOLOGIC BENEFITS OF HSDPHSIOLOGIC BENEFITS OF HSD

• R!p(' $s+$t(8 +$9(/(;!t($& $, 8e//u/!" >!te" (&t$

t)e 9/$$' $/u+e• ?$/u+e ep!&s($& $, HSD (s eu!/ t$ 10 t(+es t)!t

$, RL

• Hpe"$s+$t(8 !s$'(/!t!t($& $, 9$t) sste+(8 !&'

pu/+$&!" esse/s• 8!"'(!8 ee8t(e&ess 9e8!use $, p"e/$!' !&'

!,te"/$!' !s$'(/!t!t($&

• 8!"'(!8 8$&t"!8t(/(t

• HSD )!s 9ee& s)$>& t$ 9e ee8t(e !&' s!,e >(t)p"ee(st(&g 'e)'"!t($&

• A&(+!/ stu'(es < $s+$/!"(t p"ee&t T-8e//'ep"ess($& !&' &eut"$p)(/ !8t(!t($&

• su"(!/ (& )e!' !&' pe&et"!t(&g (&*u" p!t(e&t


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PERMISSI?E HPOTENSIONPERMISSI?E HPOTENSION

• US A"+< t$ (+p"$e Je/' "esus8(t!t($&. >(t)epe8t(&g 'e/!e' "esus8(t!t($& !&' /(+(te'!!(/(9(/(t $, "es$u"8es

• T$ !$(' "e-9/ee'(&g

• M$st/ (& !&(+!/ stu'(es< BP 60-0 ++ Hg"esu/te' (& /$&ge" su"(!/ t)!& MAP K0 ++ Hg

• St(// (& uest($&s <

– L!te 8$+p/(8!t($& ,"$+ (&8$+p/ete

"esus8(t!t($&– BP K0 ++ Hg >$u/' 9e (&!'eu!te t$

(+p"$e 8e"e9"!/ pe",us($& !,te" )e!' (&*u"


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E!"/ !&' L$&g-Te"+Su"(!/

C!"'(!8 $utput (& 6 g"$ups

+ramer C J Trauma 200354 :S9-99


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E!"/ !&' L!te P/!s+! $/u+eEp!&s($&

+ramer C J Trauma 200354 :S9-99


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INTRAOSSEOUS INFUSIONIO

• E!s !&' "!p(' t$ !pp/E!s !&' "!p(' t$ !pp/

• C$&s(ste&t >(t) t)e 8$&8ept $, s+!//-C$&s(ste&t >(t) t)e 8$&8ept $, s+!//-$/u+e "esus8(t!t($& >(t) HSD$/u+e "esus8(t!t($& >(t) HSD

• Be 8!"e,u/ >(t) p"$9!9(/(t $, /$8!/Be 8!"e,u/ >(t) p"$9!9(/(t $, /$8!/

8$+p/(8!t($&s8$+p/(8!t($&s


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)ST paca$e)ST *one pro*e cluter,in!uion tu*e on the centernee#le

)ST in!uion tu*e inpoition

%&n$ me#ical, Calin M. J Trauma 2000 no/,


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The6'

The J7

The S)

Calin M. J Trauma 2000


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INTRAOSSEOUS INFUSION DE?ICESINTRAOSSEOUS INFUSION DE?ICES

FDA !pp"$e'FDA !pp"$e'

• FASTFAST < F("st A88ess ,$" S)$8# !&' T"!u+!< F("st A88ess ,$" S)$8# !&' T"!u+!

P&g Me'(8!/P&g Me'(8!/

• BIGBIG < B$&e I&*e8t($& Gu& W!(s Me'(8!/< B$&e I&*e8t($& Gu& W!(s Me'(8!/

• SFSF < Su"F!st C$$# C"t(8!/< Su"F!st C$$# C"t(8!/• N N < !+s)('( Nee'/e B!te"< !+s)('( Nee'/e B!te"

S(te $, (&,us($& ste"&!/ &$t8)8+ 9e/$> ste"&!/ &$t8)• BIG. SF. NBIG. SF. N < Me'(!/ P"$(+!/ T(9(! $" D(st!/< Me'(!/ P"$(+!/ T(9(! $" D(st!/

Me'(!/ T(9(!Me'(!/ T(9(!

• Ot)e" s(tesOt)e" s(tes < ,e+u". (/(!8 8"est. )u+e"us.< ,e+u". (/(!8 8"est. )u+e"us.

"!'(us !&' 8/!(8/e"!'(us !&' 8/!(8/e


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AD?ANCED TRAUMA LIFE SUPPORTAD?ANCED TRAUMA LIFE SUPPORT

ATLSATLS

• Sste+(8 st!&'!"'(;e' !pp"$!8) t$ t)et"e!t+e&t $, t"!u+! 8!su!/t(es t)!t )!s

9ee& su88ess,u/ (& 8((/(!& t"!u+!

• Me'(8!/ t"!(&(&g ,$" A"+ F$"8es (& +!&8$u&t"(es (s 8u""e&t/ 9!se' $& t)e

p"(&8(p/es t!ug)t (& ATLS 8$u"se. >)(8)>!s !pp/(e' t$ t)e 8$+9!t e&("$&+e&t!&' te"+e' M(/(t!" L(,e Supp$"t


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INITIAL FLUID RESUSCITATION OFINITIAL FLUID RESUSCITATION OF

COMBAT CASUALTIES -1COMBAT CASUALTIES -1

• T)e s(&g/e +!*$" 8!use $, 'e!t) (&p$te&t(!// s!/!ge!9/e 9!tt/eJe/'

8!su!/t(es (s )e+$"")!ge

• App"$(+!te/ 20 $, t)ese 'e!t)!"e p"ee&t!9/e (, t)e 9/ee'(&g 8!& 9e

u(8#/ 8$&t"$//e' $" +(&(+(;e' !&'t"e!te' 9 !pp"$p"(!te "esus8(t!t($&:u('s


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• Resus8(t!t($& >(t) (s$t$&(8 8"st!//$('s.(&8/u'(&g RL !&' !"t(J8(!/ 8$//$('s. e/(8(tsee"e (++u&e !8t(!t($& !&' !& up-"egu/!t($& $, 8e//u/!" (&*u" +!"#e"s4

• T)(s ee8t (s &$t see& >(t) p/!s+!. &!tu"!/8$//$('s !/9u+(& !&' ,"es) >)$/e 9/$$'

• Hpe"t$&(8 :u('s 8!use supp"ess($& $,&eut"$p)(/ !8t(!t($& !&' ! +(/'e" (&8"e!se(& t)e ep"ess($& $, 8e// (&*u" +!"#e"s

INITIAL FLUID RESUSCITATION OFINITIAL FLUID RESUSCITATION OF

COMBAT CASUALTIES -2COMBAT CASUALTIES -2


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Rhee %, +outoa 8 an# lam H6, J Trauma

2003 54 : S52-S/2

ENDOTHELIAL-LEU%OCTEINTERACTION


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Chau#r& 'H etal J Trauma, 200354 : S11-


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PASSAGE OF NEUTROPHILS FROM THE?ASCULATURE TO THE AREA OF INUR

OR INFECTION

%acual J etal, J Trauma 2003 54 : S133-S140


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%acual J etal, J Trauma 2003 54 : S133-S140

MICRO?ASCULAR DISTURBANCESMICRO?ASCULAR DISTURBANCES

IN SIRSIN SIRS


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INTRA?ITAL?IDEOMICROSCOP 70

MINUTES AFTER RLRESUSCITATION

LEUCOCTE ADHESION WITHDIFFERENT FLUIDRESUSCITATION

%acual J etal, J Trauma 2003 54 :

The Rollin$

#herenteucoc&te


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PROLONGED SHOC% ANDPROLONGED SHOC% AND

MODSMODS

• S)$8# (s ! s&'"$+e $, )p$te&s($& $,su8(e&t see"(t t$ e/(8(t s(g&s !&'s+pt$+s $, e&'-$"g!& )p$pe",us($&

• P"$,$u&' !s$8$&st"(8t$" "esp$&se (stp(8!/ $, !8ute )e+$"")!g(8 s)$8# !&'!8ute 8!"'($ge&(8 s)$8#4

• P"$/$&ge' )e+$"")!ge $" 8!"'($ge&(8s)$8# +! e$/e (&t$ ! /!te(""ee"s(9/e p)!se 8!"!8te"(;e' 9!s$'(/!t!t($&


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?ASCULAR SMOOTH MUSCLE TONE INACUTE HEMORRHAGIC SHOC%-

?ASOCONSTRICTION

Ra*in J + et al, J Trauma 2003, 54: S149-


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?ASCULAR SMOOTH MUSCLE TONE INIRRE?ERSIBLE HEMORRHAGIC SHOC%-

?ASODILATATION

Ra*in J + etal, J Trauma 2003, 54: S149-


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?ASOPRESSIN BLOC%ADE OF?ASODILATATION

Ra*in J + etal, J Trauma 2003, 54: S149-


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an "a& ''' C" et al , J Trauma 2003, 54 :


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A/g$"(t)+ ,$" "est$"!t($& $,A/g$"(t)+ ,$" "est$"!t($& $,

$ge& t"!&sp$"t$ge& t"!&sp$"t Clinical hypermetabolismClinical hypermetabolism

Control hemorrhageControl hemorrhage YesYes

Drain abscessDrain abscess Adequate source control Adequate source control

Debride dead tissueDebride dead tissue and and

Flow-dependent oxygen consumptionFlow-dependent oxygen consumption

Flow-dependent lactate productionFlow-dependent lactate production NoNo YesYes

Metabolic supportMetabolic supportPreload assessmentPreload assessment add volumeadd volume

Adequate Adequate

Afterload assessment Afterload assessment add vasodilator add vasodilator

Adequate Adequate

notropic assessmentnotropic assessment add inotropeadd inotrope

Adequate Adequate

Consider vasopressor Consider vasopressor add vasopressor add vasopressor

NoNo

HypotensionHypotension

• Pasquale et al. Critical Care. In: Basic Surgery 1995. P.198Pasquale et al. Critical Care. In: Basic Surgery 1995. P.198


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CONCLUSIONSCONCLUSIONS

14 T)e 8u""e&t p"!8t(8e $, us(&g /!"ge-$/u+e (s$t$&(8 8"st!//$(' (&,us($&!/$&e ,$" 8$+9!t "esus8(t!t($& (s &$t

$pt(+!/

24 F/u(' "esus8(t!t($& $, 8$&t"$//e')e+$"")!ge (& t)e 9!tt/e Je/'. s)$u/'

9e !& (&(t(!/ 250 +/ (&,us($& $, HSD.!'+(&(ste"e' s/$>/ 10-15 +(&utes.,$//$>e' 9 ! se8$&' 250 +/ !t HSD$&/ (& t)ese pts >)$ ,!(/ t$ st!9(/(;e


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3434 T)e (&,us($& $, HSD +! 9e ,$//$>e' 9T)e (&,us($& $, HSD +! 9e ,$//$>e' 9(s$t$&(8 8"st!//$(' !/$&e !s 8!"e p"$g"esses(s$t$&(8 8"st!//$(' !/$&e !s 8!"e p"$g"esses

6464 Pe"+(ss(e )p$te&s(e "esus8(t!t($& )!sPe"+(ss(e )p$te&s(e "esus8(t!t($& )!s

9ee& (&t"$'u8e t$ !$(' "e-9/ee'(&g !&'9ee& (&t"$'u8e t$ !$(' "e-9/ee'(&g !&'>$"se& $ut8$+e $, see"e )e+$'(/ut($&>$"se& $ut8$+e $, see"e )e+$'(/ut($&

5454 I4?4 8!t)ete" p/!8e+e&t "e+!(&s t)e g$/'I4?4 8!t)ete" p/!8e+e&t "e+!(&s t)e g$/'

st!&'!"' ,$" !s8u/!" !88ess !&' s)$u/' &$tst!&'!"' ,$" !s8u/!" !88ess !&' s)$u/' &$t9e "ep/!8e. 9ut (& s(tu!t($&s su8) !s s)$8#.9e "ep/!8e. 9ut (& s(tu!t($&s su8) !s s)$8#.(&t"!$sse$us IO (&,us($& +! p"$('e !&(&t"!$sse$us IO (&,us($& +! p"$('e !&!/te"&!t(e "$ute $, !s8u/!" !pp"$!8)!/te"&!t(e "$ute $, !s8u/!" !pp"$!8)

CONCLUSIONSCONCLUSIONS


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Update in Fluid Rescusitation

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