0071643192.pdf

DIAGNOSIS

■ Best diagnosed with a careful exam

■ Radiographic studies (X-ray, CT, MRI) may also help in establishing the

diagnosis.

TREATMENT

■ Crystalloid bolus

■ Atropine

■ Vasopressor agents to maintain SBP > 90–100 mmHg

■ Norepinephrine

■ Phenylephrine

■ Dopamine

■ Monitor urine output as a measure of adequate perfusion.

FLUID RESUSCITATION

There are myriad options for fluid resuscitation available to the emergency

physician. They can be categorized as crystalloids, colloids, and blood

products.

Crystalloids

Isotonic electrolyte solutions, including normal saline (0.9% NaCl) and

Ringer’s lactate (NaCl, CaCl 2 , KCl, Na-lactate)

CHARACTERISTICS

■ Do not aid in O 2 transport.

■ Are hypooncotic →one-third of the volume infused remains in the intra-

vascular space after 20 minutes

CLINICALINDICATIONS

■ Clinically significant hypovolemia

■ Regardless of the cause of hypovolemia, crystalloids should always be the

first type of fluid given.

Colloids

Colloid solutions contain large-molecular-weight particles of high osmolarity

that cause fluid to move into the intravascular space. They do not augment

O 2 transport.

AVAILABLE PRODUCTS

■ Albumin

■ Bovine or human protein

■ Twenty-five percent solution administered in 50-mL or 100-mL

aliquots

■ 100 mL felt to be equivalent to 1 L of crystalloid

■ Potential for infectious complications

RESUSCITATION

One-third of the volume of

infused crystalloid remains

intravascular after 20 minutes.

There is no proven benefit of

colloids over crytalloids in

volume resuscitation.

Albumin has the potential for

infectious complications.

Shock in a trauma patient

shouldalwaysbe presumed

to be secondary to

hemorrhage.