S3C26 - Fluid and Blood Resuscitation

Question 1

Lethal Triad

Answer 1

1. coagulopathy
2. acidosis
3. hypothermia

-agressive fluid resusc can cause a coagulopathy from hemodilution

Question 2

Common Causes of coagulopathy in trauma

Answer 2

• massive hemorrhage
• hypothermia
• consumption of clotting factors
• consumption of platelets
• dilution of clotting factors and platelets
• trauma-induced fibrinolysis
• massive blood TFN
• hypocalcemia

Question 3

Estmiate of circulating volume in adults:

Answer 3

• 7% of ideal body weight
• eg. 5L in a 70kg person
• which is aobut 3L plasma and 2L RBC

Question 4

Pulse pressure in hemorrhage

Answer 4

• narrows
• b/c of arterial/venous vasoconstriction

Question 5

HR in hemorrhage

Answer 5

• usually increases
• however 30% of pts with intra-abdominal hemorrhage will have bradycardia from increased vagal tone in response to hemoperitoneum

Question 6

Classes of Hemorrhage

Answer 6

-Class I:

• <15 % blood loss (750cc)
• Sx: minimal tachy, Nl BP, may not need fluids

-Class II:

• <30 % blood loss (750-1500cc)
• Sx: tachy, narrow PP, mild hypotension, mild cognition changes
• fluid resusc, usually don’t need PRBC

-Class III:

• <40% blood loss (1500-2000cc)
• Sx: tachy, sever hypotension, decreased LOC
• give fluids and PRBC
• Class IV:
• >40% blood loss (>2000cc)

Question 7

3:1 rule with crystalloids

Answer 7

• because so much of the NS/RL given ends up extravascular, for every 3 units give only 1 ends up staying intravascular
• therefore a loss of 1L of blood requires 3L of NS to restore normovolemia

Question 8

Hemorrhage: blood transfusions

Answer 8

• if there is minimal or only modest hemodynamic improvement after rapid insuion of 2-3L of crystalloids (NS/RL) then blood is required
• may also give blood right away if obvious massive hemorrhage

Question 9

Permissive Hypotension

Answer 9

• target systolic 90-100 and MAP 60-10
• theory that normalizing BP will dislodge delicate clots as well as lower the oxygen carrying capacity of the blood

Question 10

Massive Hemorrhage

Answer 10

• defn: >10 units PRBC in 24h
• if multiple PRBC units required consider transfusing platelets and FFP at 1:1:1 ratio to address any coagulopathy issues