Emergency Medicine Book

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Fluid Resuscitation in Trauma

Aka: Fluid Resuscitation in Trauma
  1. See Also
    1. Hemorrhage Evaluation
  2. Indications for Fluid Therapy: Signs of shock
    1. Mottled or pale color
    2. Cool skin
    3. Diminished peripheral pulses
    4. Delayed capillary pulses despite normal Ambient temp
    5. Mental status changes
    6. Oliguria
    7. Shock may be present despite normal Blood Pressure
  3. Available Fluids for Volume Expansion
    1. Crystalloid Isotonic Solution
    2. Colloid Solution
    3. Blood Products
      1. Inadequate improvement after 2 crystalloid boluses
  4. Monitoring
    1. Reassess systemic perfusion after each bolus
  5. Dosing
    1. Bolus Volumes given rapidly (<20 minutes)
      1. Adult: 1-2 Liter Bolus IV
      2. Child: 20 ml/kg LR or NS IV or IO
    2. Repeat dosing
      1. May require 2-3 boluses within first hour
      2. Septic shock may require 4 boluses in first hour
  6. Technique: Children
    1. Use 35-50 cc syringe attached to inline 3-way stop-cock
  7. Precautions
    1. Use only LR or NS for initial boluses
    2. Do not use dextrose solutions
      1. Induces osmotic diuresis
      2. Results in Hypokalemia
      3. Worsens ischemic brain injury

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