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Re: My case list...From: Douglas Krell MD (dougkrell@roadrunner.com)Sat May 30 12:16:45 1998
>Now to my question. We have all seen pts with stable BPs, no >tachycardia, with 1000cc hemoperitoneum. But with the same amount of >*rapid* blood loss, we see hemodynamic instability. Once bleeding has >been relatively controlled, do hypotension and tachycardia mandate a >more aggressive approach? Or can we safely wait while tanking up the >patient with IV fluids, etc? I think it helpful to consider the elements that are involved when hemorrhage occurs: 1) volume and fluid status 2) peripheral vascular resistance 3) blood components and their function such as O2 carrying capacity, coagulation elements, plasma proteins etc... Patients under anesthesia may have an exaggerated response to hemorrhage because of decreased peripheral vascular resistance. But anytime a person experiences a drop in pressure and a tachycardic response, there is a need to act aggressively to replace volume to initially restore perfusion and prevent the complications of irreversible shock. Next you must address the oxygen deficit by replacing red blood cell mass. Then an assessment of the total lost volume in replacing coagulation elements is important. Certainly a studied assessment of the reason for the blood loss and implementing ways to stop it are ongoing maneuvers that should take place simultaneously to the carefull assesment and management of total blood volume.
-- Douglas Krell MD
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