What is controlled resuscitation
Balancing the goal of organ perfusion and tissue oxygenation
with the avoidance of rebleeding by accepting a lower than
normal blood pressure has been termed controlled
resuscitation , balanced resuscitation, hypotension
resuscitation, permissive, hypotension.
early administration of
______________________________________________ can prevent the
development of coagulopathy and thrombocytopenia.
Early administration of blood products and platelets can
prevent the development of coagulopathy and
thrombocytopenia.
The volume of urinary output is a reasonable sensitive
indicator of renal perfusion, normal urine volumes generally
imply adequate renal blood flow, if not modified by underlying
kidney injury, marked hyperglycemia, or the administration of
diuretic agents.
For this reason, urinary output is used to monitor renal blood
flow.
,Adequate replacement during resuscitation should produce:
Adult
Child
Infant
Adult 0.5ml/kg/hr
Child 1 ml/kg/hr
Infant 2 ml/kg/hr (under 1 year of age)
The inability to maintain these levels of urine output or an
increase in specific gravity indicates ?
Inadequate resuscitation
Patients in early hypovolemic shock have
__________________________________________ from tachypnea,
which is followed by mild _____________________________________.
And does not require treatment.
Patients in early hypovolemic shock have respiratory alkalosis
from tachypnea, which is followed by mild metabolic acidosis
And does not require treatment.
Persistent acidosis is usually caused by :
Inadequate resuscitation or ongoing blood loss.
, Do not use ___________________________________ to treat
metabolic acidosis fro hypovolemic shock
Sodium Bicarbonate
Treat metabolic acidosis in the setting of injury /shock with:
Fluids, Blood, Hemorrhage Control
Define - Rapid Responders (r/t blood loss)
Those patients that improve after the initial fluid bolus. They
are believed to have suffered less then 15% blood volume loss.
Define - Transient Response
Those that begin to show deterioration when as initial fluid
resuscitation is slowed. Most of these patients have 15% to 40%
blood loss.
Define - Minimal or No Response -
Failure to respond to crystalloid and blood administration in
the ED dictates need for immediate, definitive interventions.
(Angioembolization / surgery)