1.Fluid Resuscitation Assem Adel Moharram Lecturer of Anesthesia & Intensive Care Ain Shams University

2. C...Circulation 3. Body Water 4. Hypovolemic Shock Trauma: Solid organ injury Pulmonary parenchymal injury Myocardial laceration/rupture Vascular injury Retroperitoneal hemorrhage Fractures Lacerations Epistaxis Burns GI Tract: Esophageal varices Ulcer disease Gastritis/esophagitis Mallory-Weiss tear Malignancies Vascular lesions Inflammatory bowel disease Ischemic bowel disease Infectious GI disease Pancreatitis WWW.SMSO.NET 5. Hypovolemic Shock Vascular: Aneurysms Dissections AV malformations Reproductive Tract: Vaginal bleeding Malignancies Miscarriage Metrorrhagia Retained products of conception Placenta previa Ectopic Pregnancy Ruptured ovarian cyst WWW.SMSO.NET 6. Some tips for Resuscitation. 7. Choice of fluids Crystalloids Colloids Blood products Whole blood PRBC FFP Platelets 8. Crystalloids Normal saline Ringers Lactated Ringers Ringer Acetate Colloids Hestril Voluven Albumin Dextran 9. Advantages Crystalloids Inexpensive. Use for maintenance fluid and initial resuscitations Promote U.O.P Intravascular half-life 20-30 minutes. Colloids plasma volume Less peripheral oedema Smaller volumes for resuscitation Intravascular half-life 3-6 hours. 10. Disadvantages Crystalloids Dilute plasma protien Peripheral edema. pulmonary edema. Colloids Expensive. Coagulopathy. Anaphylactic reaction. 11. Whole blood: Hct 40%. Increase haemoglobin about 0.5 g/dl. Use: primarily in haemorrhagic shock. Packed red blood cells (PRBCs): Hct 60-75%. Increase haemoglobin about 1 g/dl. Volume 250350 ml. 12. Fresh frozen plasma (FFP): Contains all coagulation factors with no platelets. Use: Reversal of warfarin effects, coagulo pathy & 13. Platelets: Use: Thrombocytopaenia and abnormal platelets function. 14. Cryoprecipitate: Use: Treatment of von Willebrand disease & fibrinogen deficits. 15. WaitPlease dont forget 16. Risks of Blood products transfusion 1. Transmission of infection. 2. Citrate toxicity 3. Acid-base change. 4. Decrease 2,3 DPG. 5. Hyperkalaemia. 6. Dilutional coagulopathy. 7. Volume overload. 8. Hypothermia. 17. Amount of Fluids for Resuscitation.. EBV x (Hi - Hf) Hi = ABL Hi = initial Hct Hf = final lowest acceptable Hct Allowable Blood Loss (ABL)* 18. Estimated blood volume Age Blood volume Premature Neonates 95 mL/kg Full Term Neonates 85 mL/kg Infants 80 mL/kg Adult Men 75 mL/kg Adult Women 65 mL/kg 19. E.g. 70 Kg male patient , Hi 40, Hf 30 EBV=75x70=5250 ABL= 5250x(40-30)/40=5250x = 1312 ml 20. Amount of Fluids for Resuscitation.. Crystalloids 3-4 times N.Bnever D5 21. Colloids 1 : 1 22. That means you need a 23. Question 1 30 years old healthy male Motor car accident Loss of one litre blood in 30 min due to vascular injury Now , bleeding is controlled Bp 90/50 ,pulse 100 What type of fluid..? Whole blood Packed RBCs FFP Crystalloids Colloids 24. Question 2 70 years old patient Ischemic heart ds On anticoagulant (Marevan) for AF. Severe epistaxis Lost 1 litre of blood BP 90/50 ,pulse 100 What type of fluid..? Whole blood Packed RBCs FFP Crystalloids Colloids 25. What about an extra 600 ml fresh blood, warm,zero% infection, Full of coagulation factors Full of platelets. and 26. Leg Elevation. 27. Routes for Resuscitation Central line.. versus Peripheral Venous cannula.. 28. Flow equation is the key..!! 29. 15-20 cm 5-6 cm 30. Queen of the day 31. Cannula!!! 32. The difference is. 33. . 34. Preparation.5 Ps 35. Proper position Patient Doctor 36. Tourniquet .. 37. Sterilization.. 38. Knowledge.. 39. Fixation.. 40. Craniotomy