Chest Injuries & hypovolaemia

Question 1

Inadequate perfusion associated with hypovolaemia - VSS aims

Answer 1

• Aiming for HR <100bpm and BP >100mmHg (MAP 70-80mmHg)
• Penetrating trunk injury, suspected AAA or uncontrolled haemorrhage, accept palpable carotid pulse with adequate conscious state )MAP 60-90mmHg)

Question 2

Neurogenic shock from complete SCI management

Answer 2

• Maximum of 500mL NaCl bolus to correct hypotension. No further doses if SCI is the sole injury
• Up to 5ml/kg in children

Question 3

Management of Inadequate perfusion associated with hypovolaemia

Answer 3

1. Identify and manage haemorrhage, fractures, pain, tension pneumothorax and hypoxia.
2. Consider modyfiying factors: AAA, SCI, penetrating trunk, uncontrollable haemorrhage.
3. HR <100 and BP >100mmHg: No fluid required.
4. Isolated tachycardia: NaCl up to 20ml/kg
5. If HR >100 and BP < 100mmHg: NaCl up to 20ml/kg.
6. Paediatrics: No fluid required in adequate perfusion. Inadequate or no perfusion: IV access and NaCl up to 20ml/kg.