Kristan Staudenmayer, MD Stanford University, Stanford, CA
|
|
- Elvin Kelly
- 5 years ago
- Views:
Transcription
1 Kristan Staudenmayer, MD Stanford University, Stanford, CA
2
3 Fluid resuscitation Variety of fluids How to administer What you do DOES matter
4
5 WWII 1942 North Africa high mortality from hemorrhaghic shock By 1943, blood transfusions for shock with improved survival Korean War Renal failure in 1:200 casualties who survived
6 Moyer 1 & Shires 2 Hypothesized that irreversible shock was due to an imbalance in salt content in extracellular fluids. Showed could improve survival from shock with blood + crystalloid 1 Moyer CA, Burns, shock, and plasma volume regulation, Shires et al., Fluid therapy in hemorrhagic shock. Arch Surg, 1964
7 Vietnam War Use of crystalloids was the standard of care Improved survival and less renal failure Da Nang Lung Moved into civilian practice ARDS Abdominal compartment syndrome Coagulopathy Decreased gut motility Hyperglycemia
8 Start by talking about which fluids to use Crystalloids Colloids Hypertonic solutions Blood
9 Start by talking about which fluids to use Crystalloids Colloids Hypertonic solutions Blood
10 Crystalloids, collioids, blood?
11 Crystalloids NS and Lactated ringers 1/3 remains intravascular Normal Saline Large volumes of NaCl nongap acidosis
12
13 Hypertonic Saline Solutions Resuscitation: 7.5% +/ Dextran TBI: 3%
14 Hopeful laboratory findings Intravascular expansion superior to LR and NS Decreased inflammation
15 Hypertonic Saline Safety concerns: Central pontine myelinolysis Hypertension No evidence to date have documented any adverse effects of hypernatremia (Not all trials have been designed to detect this complication among study subjects)
16 The largest hypertonic saline studies to date: Trauma Head injuries Pre hospital randomized controlled clinical trials Compared: 8oz NaCl vs.8oz HTS vs. 8oz HTS w/ dextran These trials was halted after enrollment of 1,000 patients because of an inability to detect a 28 day survival benefit on interval
17 Reports on interval outcomes still pending Hypertonic saline unproven, but still candidate for future research Military interested in continuing HTS research
18 Function Vary by MW in length of time they remain in the circulatory system Different molecular structures = different complications Types Albumin 6% Hydroxyethylstarch (HES) solutions Hextend: HES in lactated electrolyte solution Hespan: HES in NS Dextran Gelatins Combined Hypertonic Dextran solutions
19 Ex: Albumin (MW 70,000 daltons) Volume Expansion 100 ml of 25% albumin 3 5 X 500 ml of 5% albumin 500cc However, rapidly diffuses out: Estimated ~30 minutes in normal subjects Likely higher in subjects with increased intravascular permeability (eg, critically ill, sepsis, trauma, burn)
20 Ex: Hespan (6% hetastarch in 0.9% sodium chloride; 600,000 daltons) Volume expansion Same effect as 5% albumin Diffusion Urinary clearance 33% to 40% within 24 hours; ~62% within 72 hours Overall duration 6 36 hours
21 Associated complications Coagulopathy Bleeding Anaphylaxis Complications associated with specific formulas Large volumes of Hespan, Hextend may interfere with platelet function, prolong PT/PTT. Clinically Hextend has not been associated with coagulation abnormalities in doses >20 ml/kg up to a total of 5000 ml
22 Kaplan-Meier Estimates of the Probability of Survival Randomized Controlled Trial 16 ICUs in Australia and New Zealand 7,000 patients 4% albumin vs. 0.9% NaCl Mortality at 28 days The SAFE Study Investigators,. N Engl J Med 2004;350:
23 Kaplan-Meier Estimates of the Probability of Survival The SAFE Study Investigators,. N Engl J Med 2004;350:
24 The SAFE Study Investigators. N Engl J Med 2007;357:
25 Crystalloid vs Number trials Pooled RR Mortality 95% CI Albumin HES Gelatin Dextran HTS + Dextran Perel et al., Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database of Systematic Reviews 2007
26
27 Summary LR and NS are still considered the top choices Make sure brand of LR does not contain D lactate Hypertonic and saline and colloids: No evidence to support their use over crystalloids Likely that we will see further studies with more well defined populations that do benefit from these solutions. HTS and newer synthetic colloids likely will also be shown to be safe. Harm with albumin in head injured patients.
28 The bleeding patient who needs blood
29 Whole blood transfusions component therapy 1980s Allowed longer storage Improved resource utilization Products administered based on lab values But this does not work as well for actively bleeding patients
30 Acquired or Congenital Coagulopathy Injury Resuscitation Coagulopathy Bleeding Diatheses, medications, etc Coagulopathy of Trauma Lethal Triad
31 Acquired or Congenital Coagulopathy Injury Resuscitation Coagulopathy Bleeding Diatheses, medications, etc Coagulopathy of Trauma Lethal Triad
32 Brohi K, et al. J Trauma. Jun 2003;54(6):1127
33 Brohi K, et al. J Trauma. Jun 2003;54(6):1127
34 3 4x increased mortality 8x higher mortality within 24 hours Higher incidence MOF Increased transfusion requirements Brohi K, et al., Ann Surg. May 2007;245(5): Maegele M, et al. Injury. Mar 2007;38(3):
35 Bleeding Tissue Hypoxia Fluid Replacement RBC Transfusion Acidosis Dilution Hypothermia Coagulopathy
36 Borgman MA, et al. J Trauma. 2007;63:
37
38 Pulmonary morbidity may be higher with high Plasma resuscitation Transfusion related acute lung injury (TRALI) TRALI is the commonest cause of transfusion related death Anti neutrophil antibodies are commonly in the plasma from multiparous female donor TRALI frequency is higher in recipients from female donors Male only plasma policy has been adopted in many countries with marked reductions in TRALI
39 Gonzalez et al., J Trauma 2007 Advocated correcting INR to <1.3 with FFP Reported a high incidence of early and lethal acute respiratory distress syndrome [10]. Th e aggressive FFP transfusion was aimed Sperry, J Trauma 2008 Better survival with 1.5:1 resuscitation ARDS more common with patients with more FFP
40 When a patient is actively bleeding, blood products are preferred over crystalloids to better manage coagulopathy Know that bleeding trauma patients likely have a coagulopathy that needs to be addressed early. Many centers now administer plasma early during the resuscitation
41 The ideal use of plasma is still a matter of debate and does not come without risk. If you don t need blood or plasma, don t use blood products for volume expansion!
42 Maybe more fluid is not better
43 Pop the clot Timing and volume Early vs. delayed Large vs. small
44 Number of trauma victims with hypotension: 6 8% 1/3 are likely non survivable 1/3 are hypotensive due to other causes (tension pneumothorax, tamponade, drugs/etoh) Hypotensive resuscitation as a strategy is only relevant in: 1/3 of hypotensive patients 2 3% all trauma patients
45 Mapstone et al., J Trauma 2003 Meta analysis hypotensive strategies Normotensive versus hypotensive resuscitation Pooled risk ratio death was 0.37 (95% CI, )
46 Mapstone et al., J Trauma 2003 But also compared 44 animal trials of fluid versus no fluid There was marked heterogeneity in the effect of fluid resuscitation on the risk of death, much of which was explained by the hemorrhage model used.
47 Bickell W et al. N Engl J Med 1994;331:
48 Revelation of methodological errors: Did not consider patients who died in the field Did not point out overlapping confidence intervals 95% CI Immediate resus 57 68% 95% CI Delayed resus 65 75% Re evaluation found: Initial statistics do not confirm difference When consider those who died in the field, lose all statistical differences in mortality.
49 Population OR death 95% CI Significant? Bickell 1994 Hypotensive pen. trauma 1.26 ( ) No Blair 1986 Hypotensive GI bleeding 5.4 ( ) No Turner 2000 Hypotensive trauma patients 1.06 ( ) No Dunham 1991 Hypotensive trauma patients 0.8 ( ) No Dutton 2002 Hypotensive trauma patients 1.0 ( ) No Kwan I, et al., Timing and volume of fluid administration for patients with bleeding. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD DOI: / CD002245
50 Marshall et al. asked the question: Is it blood pressure or is it HEMODILUTION?
51 Used uncontrolled hemorrhage model in rats Found hemodilution was more associated with mortality and markers of shock vs. blood pressure
52 Hemodilution vs. Pressure Effects of Hemodilution on Long Term Survival in an Uncontrolled Hemorrhagic Shock Model in Rats. Marshall, Harry; Capone, Antonio; Courcoulas, Anita; MD, MPH; Harbrecht, Brian; Billiar, Timothy; Udekwu, Anthony; Peitzman, Andrew Journal of Trauma Injury Infection & Critical Care. 43(4): , October Group I, MAP = 80 mm Hg with LR resuscitation only Group II, MAP = 80 mm Hg with Whole Blood + LR; Goup III, MAP = 40 mm Hg with LR only ; Group IV, MAP = 40 mm Hg with Whole Blood + LR. Williams & Wilkins All Rights Reserved. Published by Lippincott Williams & Wilkins, Inc. 2
53 Effects of Hemodilution on Long Term Survival in an Uncontrolled Hemorrhagic Shock Model in Rats. Marshall, Harry; Capone, Antonio; Courcoulas, Anita; MD, MPH; Harbrecht, Brian; Billiar, Timothy; Udekwu, Anthony; Peitzman, Andrew Journal of Trauma Injury Infection & Critical Care. 43(4): , October Survival Blood loss (ml/100g) Group 1 None Group 2 100% Group 3 75% Group 4 87% LR administered (ml) Group I, MAP = 80 mm Hg with LR only Group II, MAP = 80 mm Hg with Whole Blood + LR; Goup III, MAP = 40 mm Hg with LR only ; Group IV, MAP = 40 mm Hg with Whole Blood + LR. Williams & Wilkins All Rights Reserved. Published by Lippincott Williams & Wilkins, Inc. 2
54 Most people moving towards judicious use of fluids until have definitive control Normal BP might not be best target Before surgical control of bleeding, perhaps should target palpable pulse and adequate cerebral perfusion if no head injury is present Further work required to support this strategy as a global solution
55 Crystalloids vs. colloids Which crystalloid or which colloid? When to use blood and what products to administer? Hypotensive resuscitation?
56 Has a lot to do with the clinical scenario
57 The massively bleeding trauma patient Needs blood products Minimize crystalloid Use LR, but make sure does not have D lactate Control coagulopathy early Don t wait for labs Consider early use of Plasma If prehospital and far from definitive therapy, may err on the side of hypotensive resucitation mentating and with palpable pulse.
58 If hypotensive but not in hemorrhagic shock Don t give blood products! Crystalloid is the first line of therapy Again, probably LR over NS to minimize acidosis Colloids can be used if not responding But understand that risks will differ depending on solution (i.e. albumin in head injured patients) And understand that they might not stick around long No evidence to support one colloid over the other.
59
60
61 Riskin DJ, et al. JACS. 2009;209:198.
62 Dysregulation Immunosuppression Inappropriate inflammation Association between infection and transfusion in trauma
12/29/2014. IV/IO Therapy & Fluid Administration. Objectives. Cleansing of the soul
IV/IO Therapy & Fluid Administration Gary Hoertz, EMT-P Spokane County EMS Indications for IV Access Types of Intravenous Access IV fluids Flow Rates Fluid resuscitation Objectives Cleansing of the soul
More informationSurgical Resuscitation Management in Poly-Trauma Patients
Surgical Resuscitation Management in Poly-Trauma Patients Andrew Bernard, MD FACS Paul Kearney MD Chair of Trauma Surgery Associate Professor Medical Director of Trauma and Acute Care Surgery UK Healthcare
More informationIV Fluids. I.V. Fluid Osmolarity Composition 0.9% NaCL (Normal Saline Solution, NSS) Uses/Clinical Considerations
IV Fluids When administering IV fluids, the type and amount of fluid may influence patient outcomes. Make sure to understand the differences between fluid products and their effects. Crystalloids Crystalloid
More informationTRAUMA RESUSCITATION. Dr. Carlos Palisi Dr. Nicholas Smith Liverpool Hospital
TRAUMA RESUSCITATION Dr. Carlos Palisi Dr. Nicholas Smith Liverpool Hospital First Principles.ATLS/EMST A- Airway and C-spine B- Breathing C- Circulation and Access D- Neurological deficit E- adequate
More informationHYPOVOLEMIA AND HEMORRHAGE UPDATE ON VOLUME RESUSCITATION HEMORRHAGE AND HYPOVOLEMIA DISTRIBUTION OF BODY FLUIDS 11/7/2015
UPDATE ON VOLUME RESUSCITATION HYPOVOLEMIA AND HEMORRHAGE HUMAN CIRCULATORY SYSTEM OPERATES WITH A SMALL VOLUME AND A VERY EFFICIENT VOLUME RESPONSIVE PUMP. HOWEVER THIS PUMP FAILS QUICKLY WITH VOLUME
More informationDr. Nai Shun Tsoi Department of Paediatric and Adolescent Medicine Queen Mary Hospital Hong Kong SAR
Dr. Nai Shun Tsoi Department of Paediatric and Adolescent Medicine Queen Mary Hospital Hong Kong SAR A very important aspect in paediatric intensive care and deserve more attention Basic principle is to
More informationEpidemiology. Case. Pre-Hospital SI and Massive Transfusion
Epidemiology Preston Maxim, MD Assoc. Professor of Emergency Medicine San Francisco General Hospital ~180,000 deaths 2007 due to trauma 25% trauma patients require 1 unit of PRBC and only 25% of those
More information"Small Volume" Resuscitation for Trauma Cases : PRO Aspects
"Small Volume" Resuscitation for Trauma Cases : PRO Aspects Jim Holliman, M.D., F.A.C.E.P. Program Manager, Afghanistan Health Care Sector Reconstruction Project Center for Disaster and Humanitarian Assistance
More informationBleeding, Coagulopathy, and Thrombosis in the Injured Patient
Bleeding, Coagulopathy, and Thrombosis in the Injured Patient June 7, 2008 Kristan Staudenmayer, MD Trauma Fellow UCSF/SFGH Trauma deaths Sauaia A, et al. J Trauma. Feb 1995;38(2):185 Coagulopathy is Multi-factorial
More informationWHAT S NEW-ISH IN ARDS MANAGEMENT AFTER TRAUMA?
WHAT S NEW-ISH IN ARDS MANAGEMENT AFTER TRAUMA? Bryce Robinson MD, MS, FACS, FCCM Associate Professor of Surgery Associate Medical Director, Critical Care Harborview Medical Center Department of Surgery
More informationTactical Combat Casualty Care Guideline Change Fluid Resuscitation for Hemorrhagic Shock in TCCC
Tactical Combat Casualty Care Guideline Change 14-01 Fluid Resuscitation for Hemorrhagic Shock in TCCC 2 June 2014 Why a change was needed: The last update to the fluid resuscitation recommendations in
More informationIntravenous Fluid Therapy in Critical Illness
Intravenous Fluid Therapy in Critical Illness GINA HURST, MD DIVISION OF EMERGENCY CRITICAL CARE HENRY FORD HOSPITAL DETROIT, MI Objectives Establish goals of IV fluid therapy Review fluid types and availability
More informationShock. William Schecter, MD
Shock William Schecter, MD The Cell as a furnace O 2 1 mole Glucose Cell C0 2 ATP 38 moles H 2 0 Shock = Inadequate Delivery of 02 and Glucose to the Cell 0 2 Cell ATP 2 moles Lactic Acid Treatment of
More information3/16/15. Management of the Bleeding Trauma Patient: Concepts in Damage Control Resuscitation. Obligatory Traumatologist Slide
Management of the Bleeding Trauma Patient: Concepts in Damage Control Resuscitation Courtney Sommer, MD MPH Duke Trauma Symposium March 12, 2015 Obligatory Traumatologist Slide In 2010 trauma was leading
More informationMaria B. ALBUJA-CRUZ, MD ALBUMIN: OVERRATED. Surgical Grand Rounds
Maria B. ALBUJA-CRUZ, MD ALBUMIN: OVERRATED Surgical Grand Rounds ALBUMIN Most abundant plasma protein 1/3 intravascular 50% of interstitial SKIN Synthesized in hepatocytes Transcapillary escape rate COP
More informationTransfusion Pitfalls. Objectives. Packed Red Blood Cells. TRICC trial (subgroups): Is transfusion always good? Components
Objectives Transfusion Pitfalls Gregory W. Hendey, MD, FACEP Professor and Chief UCSF Fresno, Emergency Medicine To list risks and benefits of various blood products To discuss controversy over liberal
More informationKay Barrera MD. Surgery Grand Rounds June 19, 2014 SUNY Downstate
Kay Barrera MD Surgery Grand Rounds June 19, 2014 SUNY Downstate Kay Barrera MD Surgery Grand Rounds June 19, 2014 SUNY Downstate Outline Why are we talking about this SCORE expectations When do we use
More information-Cardiogenic: shock state resulting from impairment or failure of myocardium
Shock chapter Shock -Condition in which tissue perfusion is inadequate to deliver oxygen, nutrients to support vital organs, cellular function -Affects all body systems -Classic signs of early shock: Tachycardia,tachypnea,restlessness,anxiety,
More informationPre-hospital Administration of Blood Products (PHBP) and Tranexamic acid (TXA): Is the Jury Still Out?
Pre-hospital Administration of Blood Products (PHBP) and Tranexamic acid (TXA): Is the Jury Still Out? Jessica K. Reynolds, MD Assistant Professor of Surgery University of Kentucky, Department of Trauma
More informationFluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE
Fluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE In critically ill patients: too little fluid Low preload,
More informationDoes a Controlled Fluid Resuscitation Strategy Decrease Mortality in Trauma Patients?
Does a Controlled Fluid Resuscitation Strategy Decrease Mortality in Trauma Patients? death Haemorrhage remains the biggest killer of major trauma patients Expected deaths will increase to 8 million/year
More informationKASHVET VETERINARIAN RESOURCES FLUID THERAPY AND SELECTION OF FLUIDS
KASHVET VETERINARIAN RESOURCES FLUID THERAPY AND SELECTION OF FLUIDS INTRODUCTION Formulating a fluid therapy plan for the critical small animal patient requires careful determination of the current volume
More informationHydroxyethyl starch and bleeding
Hydroxyethyl starch and bleeding Anders Perner Dept. of Intensive Care, Rigshospitalet University of Copenhagen Scandinavian Critical Care Trials Group Intensive Care Medicine COIs Ferring, LFB - Honoraria
More informationShock and Trauma Resuscitation
Shock and Trauma Resuscitation Bonjo Batoon, MS, CRNA Bbatoon@som.umaryland.edu Disclaimer Resuscitation is continuously evolving There is no one right way Knowing is half the battle G.I. Joe Having to
More informationDefine Shock, mostly as it relates to bleeding Options and evidence for tools of resuscitation Understand a little about coagulation and coagulopathy
Define Shock, mostly as it relates to bleeding Options and evidence for tools of resuscitation Understand a little about coagulation and coagulopathy 1:1:1 New advances Reduced perfusion of vital organs
More informationMASSIVE TRANSFUSION DR.K.HITESH KUMAR FINAL YEAR PG DEPT. OF TRANSFUSION MEDICINE
MASSIVE TRANSFUSION DR.K.HITESH KUMAR FINAL YEAR PG DEPT. OF TRANSFUSION MEDICINE CONTENTS Definition Indications Transfusion trigger Massive transfusion protocol Complications DEFINITION Massive transfusion:
More informationFluids in ICU. JMO teaching 5th July 2016
Fluids in ICU JMO teaching 5th July 2016 Objectives Physiology of fluid infusion History of fluid resuscitation Physiology of fluid resuscitation Types of resuscitation fluid The ideal resuscitation fluid
More informationFLUID RESUSCITATION SUMMARY
DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care
More informationthe bleeding won t stop? Liane Manz RN, BScN, CNCC(c) Royal Alexandra Hospital
What do you do when the bleeding won t stop? Teddie Tanguay RN, MN, NP, CNCC(c) Teddie Tanguay RN, MN, NP, CNCC(c) Liane Manz RN, BScN, CNCC(c) Royal Alexandra Hospital Outline Case study Normal coagulation
More information2 Liters. Goal: Basic Algorithm Volume Resuscitation in Trauma. Initial Fluids. Blood. Where do Blood Products Come From?
Goal: Basic Algorithm Volume Resuscitation in Trauma Sanjay Arora MD Associate Professor of Emergency Medicine Keck School of Medicine at USC Los Angeles County + USC Medical Center May 23, 2012 Initial
More informationHemorrhagic Shock in the Pediatric Patient: New Therapies and Practices
Hemorrhagic Shock in the Pediatric Patient: New Therapies and Practices Richard P. Dutton, M.D., M.B.A. In trauma, as in other subspecialties, randomized controlled trials focused on pediatric patients
More informationProceeding of the LAVECCS
Close this window to return to IVIS Proceeding of the LAVECCS Congreso Latinoamericano de Emergencia y Cuidados Intensivos Ju1. 28-30, 2011 Santiago de Chile, Chile www.laveccs.org Reprinted in IVIS with
More informationCOBIS. Fluid Resuscitation in Adults ADULT GUIDELINE
COBIS Fluid Resuscitation in Adults ADULT GUIDELINE Page 1 of 6 Fluid resuscitation in adults Summary Fluid resuscitation for adults with burns is indicated for patients with greater than 15% burns. Patients
More informationMichael Avant, M.D. The Children s Hospital of GHS
Michael Avant, M.D. The Children s Hospital of GHS OVERVIEW ER to ICU Transition Early Management Priorities the First 48 hours Organ System Support Complications THE FIRST 48 HOURS Communication Damage
More informationAlbumina nel paziente critico. Savona 18 aprile 2007
Albumina nel paziente critico Savona 18 aprile 2007 What Is Unique About Critical Care RCTs patients eligibility is primarily defined by location of care in the ICU rather than by the presence of a specific
More informationHigh Risk + Challenging Trauma Cases. Hawaii. Topics 1/27/2014. David Thompson, MD, MPH. Head injury in the anticoagulated patient.
High Risk + Challenging Trauma Cases David Thompson, MD, MPH Hawaii Topics Head injury in the anticoagulated patient Shock recognition Case 1: Head injury HPI: 57 yo male w/ PMH atrial fibrillation, on
More informationDamage Control Resuscitation. VGH Trauma Rounds 2018 Harvey Hawes
Damage Control Resuscitation VGH Trauma Rounds 2018 Harvey Hawes Example Case 25yo F in motor vehicle collision at high speed Picked up at scene by Helicopter EMS unit Initial vital signs: HR 134 BP 88/42
More informationChapter 3 MAKING THE DECISION TO TRANSFUSE
Chapter 3 MAKING THE DECISION TO TRANSFUSE PRACTICE POINTS Determine the best treatment for the patient which may include transfusion. Treat the cause of cytopenia (anaemia or thrombocytopenia) or plasma
More informationDamage Control Resuscitation
Damage Control Resuscitation H M Cassimjee Critical Care Specialist Department of Critical Care & Level 1 Trauma Unit Inkosi Albert Luthuli Central Hospital Damage Control Resuscitation only for DAMAGED
More informationHow and why I give IV fluid Disclosures SCA Fluids and public health 4/1/15. Andrew Shaw MB FRCA FCCM FFICM
How and why I give IV fluid Andrew Shaw MB FRCA FCCM FFICM Professor and Chief Cardiothoracic Anesthesiology Vanderbilt University Medical Center 2015 Disclosures Consultant for Grifols manufacturer of
More informationTXA. Things Change. Tranexamic Acid TXA. Resuscitation 2017 TXA In The ED March 31, MAST Trousers. High Flow IV Fluids.
Resuscitation 2017 In The ED March 31, 2017 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN SECURE THE ABC S MAST
More informationMassive transfusion: Recent advances, guidelines & strategies. Dr.A.Surekha Devi Head, Dept. of Transfusion Medicine Global Hospital Hyderabad
Massive transfusion: Recent advances, guidelines & strategies Dr.A.Surekha Devi Head, Dept. of Transfusion Medicine Global Hospital Hyderabad Massive Hemorrhage Introduction Hemorrhage is a major cause
More informationJOURNAL CLUB: THE FLUIDS DEBATE. Veronica Ueckermann
JOURNAL CLUB: THE FLUIDS DEBATE Veronica Ueckermann INTRODUCTION The selection and use of resuscitation fluids should be based on physiological principles. However, historically, clinical practice has
More informationBurn Resuscitation Formulas. John P. Sabra, MD Seton Surgical Group Department of Surgery Dell Medical School Austin, TX
Burn Resuscitation Formulas John P. Sabra, MD Seton Surgical Group Department of Surgery Dell Medical School Austin, TX BURN INJURY % Physiologic Change % TBSA burn Stasis BURN VASCULAR PERMEABILITY
More informationWhat is the Role of Albumin in Sepsis? An Evidenced Based Affair. Justin Belsky MD PGY3 2/6/14
What is the Role of Albumin in Sepsis? An Evidenced Based Affair Justin Belsky MD PGY3 2/6/14 Microcirculation https://www.youtube.com/watch?v=xao1gsyur7q Capillary Leak in Sepsis Asking the RIGHT Question
More informationINTRAVENOUS FLUIDS. Ahmad AL-zu bi
INTRAVENOUS FLUIDS Ahmad AL-zu bi Types of IV fluids Crystalloids colloids Crystalloids Crystalloids are aqueous solutions of low molecular weight ions,with or without glucose. Isotonic, Hypotonic, & Hypertonic
More informationFluid resuscitation in haemorrhagic shock in combat casualties
DOI 10.1186/s40696-017-0030-2 Disaster and Military Medicine REVIEW Open Access Fluid resuscitation in haemorrhagic shock in combat casualties Parli R. Ravi 1* and Bipin Puri 2 Abstract This brief update
More informationPlace of the colloids in fluid resuscitation of the traumatized patient
REVIEW C URRENT OPINION Place of the colloids in fluid resuscitation of the traumatized patient Michael F.M. James Purpose of review The examination of the recent literature aimed at analysing the most
More informationRemote Damage Control Resuscitation: An Overview for Medical Directors and Supervisors. THOR Collaboration
Remote Damage Control Resuscitation: An Overview for Medical Directors and Supervisors THOR Collaboration Agenda What is Remote Damage Control Resuscitation? Putting RDCR into Practice Control Hemorrhage
More informationWhat is the right fluid to use?
What is the right fluid to use? L McIntyre Associate Professor, University of Ottawa Senior Scientist, Ottawa Hospital Research Institute Centre for Transfusion Research CCCF, November 2, 2016 Disclosures
More informationAmjad Bani Hani Ass.Prof. of Cardiac Surgery & Intensive Care FLUIDS AND ELECTROLYTES
Amjad Bani Hani Ass.Prof. of Cardiac Surgery & Intensive Care FLUIDS AND ELECTROLYTES Body Water Content Water Balance: Normal 2500 2000 1500 1000 500 Metab Food Fluids Stool Breath Sweat Urine
More information12/1/2009. Chapter 19: Hemorrhage. Hemorrhage and Shock Occurs when there is a disruption or leak in the vascular system Internal hemorrhage
Chapter 19: Hemorrhage Hemorrhage and Shock Occurs when there is a disruption or leak in the vascular system External hemorrhage Internal hemorrhage Associated with higher morbidity and mortality than
More informationMANAGEMENT OF COAGULOPATHY AFTER TRAUMA OR MAJOR SURGERY
MANAGEMENT OF COAGULOPATHY AFTER TRAUMA OR MAJOR SURGERY 19th ANNUAL CONTROVERSIES AND PROBLEMS IN SURGERY Thabo Mothabeng General Surgery: 1 Military Hospital HH Stone et al. Ann Surg. May 1983; 197(5):
More information*Corresponding author: Key words: neurotrauma, coagulopathy
COAGULOPATHY IN NEURO TRAUMA A PROSPECTIVE ANALYSIS OF THE INCIDENCE AND CAUSES OF COAGULOPATHY IN PATIENTS WITH PURE NEURO TRAUMA AND MIXED TRAUMA ADMITTED TO THE NATIONAL HOSPITAL SRI LANKA *Jayawickrama
More informationManagement of the Trauma Patient. Elizabeth R Benjamin MD PhD Trauma and Surgical Critical Care Critical Care Symposium April 20, 2015
Management of the Trauma Patient Elizabeth R Benjamin MD PhD Trauma and Surgical Critical Care Critical Care Symposium April 20, 2015 Saturday Night 25 yo M s/p high speed MVC Hypotensive in the ED, altered
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Abdominal compartment syndrome, as complication of fluid resuscitation, 331 338 abdominal perfusion pressure, 332 fluid restriction practice
More informationPrinciples of Infusion Therapy: Fluids
Principles of Infusion Therapy: Fluids Christie Heinzman, MSN, APRN-CNP Acute Care Pediatric Nurse Practitioner Cincinnati Children s Hospital Medical Center May 22, 2018 Conflict of Interest Disclosure
More informationBREAK 11:10-11:
1. Sepsis Tom Heaps 09:30-10:20 2. Oncological Emergencies Clare Pollard 10:20-11:10 ------------------------ BREAK 11:10-11:30 ------------------------ 3. Diabetic Ketoacidosis Tom Heaps 11:30-12:20 4.
More informationHYPOTHERMIA IN TRAUMA. Kevin Palmer EMT-P, DiMM
HYPOTHERMIA IN TRAUMA Kevin Palmer EMT-P, DiMM DISCLOSURE No Financial conflicts of interest Member of the Wilderness Medical Society Diploma in Mountain Medicine Fellowship in the Academy of Wilderness
More informationFluid Treatments in Sepsis: Meta-Analyses
Fluid Treatments in Sepsis: Recent Trials and Meta-Analyses Lauralyn McIntyre MD, FRCP(C), MSc Scientist, Ottawa Hospital Research Institute Assistant Professor, University of Ottawa Department of Epidemiology
More informationResuscitation fluids in critical care
Resuscitation fluids in critical care John A Myburgh MBBCh PhD FCICM UNSW Professor of Critical Care Medicine The George Institute for Global Health University of New South Wales St George Hospitals, Sydney
More informationImplementation and execution of civilian RDCR programs Minnesota RDCR
Implementation and execution of civilian RDCR programs Minnesota RDCR Donald H Jenkins, MD FACS Associate Professor of Surgery and Director of Trauma Division of Trauma, Critical Care and Emergency General
More informationShock and Trauma Resuscitation
Shock and Trauma Resuscitation Bonjo Batoon, MS, CRNA Bbatoon@som.umaryland.edu Disclaimer Resuscitation is continuously evolving There is no one right way Knowing is half the battle G.I. Joe Having to
More informationTransfusion 2004: Current Practice Standards. Kay Elliott, MT (ASCP) SBB SWMC Transfusion Service
Transfusion 2004: Current Practice Standards Kay Elliott, MT (ASCP) SBB SWMC Transfusion Service Massive Transfusion Protocol (MTP) When should it be activated? Massive bleeding i.e. loss of one blood
More informationTransfusion Requirements and Management in Trauma RACHEL JACK
Transfusion Requirements and Management in Trauma RACHEL JACK Overview Haemostatic resuscitation Massive Transfusion Protocol Overview of NBA research guidelines Haemostatic resuscitation Permissive hypotension
More information10/4/2018. Nothing to Disclose. Liz Robertson, MD FACS October 5, 2018 Steven R. Hall Trauma Symposium Big Cedar Lodge, MO
Nothing to Disclose Liz Robertson, MD FACS October 5, 2018 Steven R. Hall Trauma Symposium Big Cedar Lodge, MO History of IV Resuscitation Review of Data for Fluid Strategies Historical Examples of IV
More informationFaith Borunda, MSN-RN, CCRN, CPTC Senior Director of Regional Operations Southwest Transplant Alliance
Faith Borunda, MSN-RN, CCRN, CPTC Senior Director of Regional Operations Southwest Transplant Alliance The Never -Ending Need 114,401 in the U.S. wait for a lifesaving transplant * United Network for Organ
More informationThicker than Water. Alisa McQueen MD, FAAP, FACEP Associate Professor of Pediatrics The University of Chicago
Thicker than Water Alisa McQueen MD, FAAP, FACEP Associate Professor of Pediatrics The University of Chicago I have no relevant financial relationships to disclose. Who is bleeding? How much and what kind
More informationFinancial Disclosure. Objectives 9/24/2018
Hemorrhage and Transfusion Adjuncts in the Setting of Damage Control Joseph Cuschieri, MD FACS Professor of Surgery, University of Washington Adjunct Professor of Orthopedics and Neurosurgery, University
More informationEarly Goal Directed Therapy in 2015: What Did the Big Trials Teach us?
Early Goal Directed Therapy in 2015: What Did the Big Trials Teach us? Mitchell M. Levy MD, FCCM Professor of Medicine Chief, Division of Pulmonary, Sleep, and Critical Care Warren Alpert Medical School
More informationSHOCK. Emergency pediatric PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital
SHOCK Emergency pediatric PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital 1 Definition Shock is an acute, complex state of circulatory dysfunction
More informationFLUID MANAGEMENT AND BLOOD COMPONENT THERAPY
Manual: Section: Protocol #: Approval Date: Effective Date: Revision Due Date: 10/2019 LifeLine Patient Care Protocols Adult/Pediatrics AP1-011 10/2018 10/2018 FLUID MANAGEMENT AND BLOOD COMPONENT THERAPY
More informationObjectives. Epidemiology of Sepsis. Review Guidelines for Resuscitation. Tx: EGDT, timing/choice of abx, activated
Update on Surviving Sepsis 2008 Objectives Epidemiology of Sepsis Definition of Sepsis and Septic Shock Review Guidelines for Resuscitation Dx: Lactate, t cultures, SVO2 Tx: EGDT, timing/choice of abx,
More informationReport Documentation Page
Report Documentation Page Form Approved OMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions,
More informationManaging Coagulopathy in Intensive Care Setting
Managing Coagulopathy in Intensive Care Setting Dr Rock LEUNG Associate Consultant Division of Haematology, Department of Pathology & Clinical Biochemistry Queen Mary Hospital Normal Haemostasis Primary
More informationTraumatic Hemorrhagic Shock: Advances In Fluid Management
Traumatic Hemorrhagic Shock: Advances In Fluid Management Abstract A number of concerns have been raised regarding the advisability of the classic principles of aggressive crystalloid resuscitation in
More informationCoagulopathy: Measuring and Management. Nina A. Guzzetta, M.D. Children s Healthcare of Atlanta Emory University School of Medicine
Coagulopathy: Measuring and Management Nina A. Guzzetta, M.D. Children s Healthcare of Atlanta Emory University School of Medicine No Financial Disclosures Objectives Define coagulopathy of trauma Define
More informationPediatric massive transfusion protocols
University of New Mexico UNM Digital Repository Emergency Medicine Research and Scholarship Emergency Medicine 2014 Pediatric massive transfusion protocols Ramsey Tate Follow this and additional works
More informationDr. Carlos Fernando Estrada Garzona. Departamento de Farmacología Universidad de Costa Rica
Dr. Carlos Fernando Estrada Garzona Departamento de Farmacología Universidad de Costa Rica OBJETIVOS FISIOLOGIA LIQUIDOS CORPORALES SOLUCIONES PARENTERALES PRINCIPIOS DE FLUIDOTERAPIA CRISTALOIDE VS COLOIDE
More informationR2R: Severe sepsis/septic shock. Surat Tongyoo Critical care medicine Siriraj Hospital
R2R: Severe sepsis/septic shock Surat Tongyoo Critical care medicine Siriraj Hospital Diagnostic criteria ACCP/SCCM consensus conference 1991 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
More informationAdult Trauma Advances in Pediatrics. (sometimes they are little adults) FAST examination. Who is bleeding? How much and what kind of TXA volume?
Adult Trauma Advances in Pediatrics (sometimes they are little adults) Alisa McQueen MD, FAAP, FACEP Associate Professor of Pediatrics The University of Chicago Alisa McQueen MD, FAAP, FACEP Associate
More informationAlbumin: rationale, use and evidence
Albumin: rationale, use and evidence Michaël Chassé, MD, MSc, FRCPC Intensivist, CHU de Québec PhD Candidate, Epidemiology, uottawa Research Fellow, Clinical Epidemiology Program Ottawa Hospital Research
More informationDamage Control Resuscitation:
American Journal of Clinical Medicine Fall 2011 Volume Eight, Number Three 129 Damage Control Resuscitation: The Case For Early Use of Blood Products and Hypertonic Saline in Exsanguinating Trauma Victims
More informationNeue Wirkungsmechanismen von Transfusionsplasma
Neue Wirkungsmechanismen von Transfusionsplasma Lorenzo ALBERIO Médecin chef Hématologie générale et Hémostase Service et Laboratoire centrale d Hématologie CHUV, Lausanne Trauma patient Bleeding Thrombosis
More informationChapter 5: Sepsis Stephen Lo
Chapter 5: Sepsis Stephen Lo Introduction Sepsis and its consequence are the bread and butter of intensive care medicine and management of it is time critical. This chapter will discuss the definitions,
More informationStaging Sepsis for the Emergency Department: Physician
Staging Sepsis for the Emergency Department: Physician Sepsis Continuum 1 Sepsis Continuum SIRS = 2 or more clinical criteria, resulting in Systemic Inflammatory Response Syndrome Sepsis = SIRS + proven/suspected
More informationPancreatitis: Critical care and Nutritional Considerations. Vance L. Smith, MD Montefiore Medical Center Acute Care Surgery
Pancreatitis: Critical care and Nutritional Considerations Vance L. Smith, MD Montefiore Medical Center Acute Care Surgery No disclosures Pathophysiology Mr. H. 42 yo male found to have gallstone pancreatitis
More informationHeme (Bleeding and Coagulopathies) in the ICU
Heme (Bleeding and Coagulopathies) in the ICU General Topics To Discuss Transfusions DIC Thrombocytopenia Liver and renal disease related bleeding Lack of evidence in managing critical illness related
More informationOverview of DoD Resuscitation Fluid Research
Overview of DoD Resuscitation Fluid Research COL Jim Atkins, MD, PhD Director, Division of Military Casualty Research Walter Reed Army Institute of Research Program Area Manager for Resuscitation Studies
More informationSHOCK Susanna Hilda Hutajulu, MD, PhD
SHOCK Susanna Hilda Hutajulu, MD, PhD Div Hematology and Medical Oncology Department of Internal Medicine Universitas Gadjah Mada Yogyakarta Outline Definition Epidemiology Physiology Classes of Shock
More informationGUIDANCE DOCUMENT FOR MASSIVE HEMORRHAGE MANAGEMENT IN ADULTS
GUIDANCE DOCUMENT FOR MASSIVE HEMORRHAGE MANAGEMENT IN ADULTS 1.0 Definitions & Acronyms 1.1 Massive Hemorrhage Event (MHE): Transfusion of a volume of blood components equivalent to a patient s estimated
More informationMy Bloody Talk. Dr Ben Turner MBBS, FANZCA, FCICM The Royal Children s Hospital, Melbourne
My Bloody Talk Dr Ben Turner MBBS, FANZCA, FCICM The Royal Children s Hospital, Melbourne Disclosures No conflicts of interest Interest in conflict Blood transfusion Massive transfusion definitions Transfusion
More informationGroupe d Intérêt en Hémostase Périopératoire
How do I treat massive bleeding? Red blood cell / plasma / platelet ratio and massive transfusion protocols Anne GODIER Service d Anesthésie-Réanimation Hopital Cochin Paris Groupe d Intérêt en Hémostase
More informationPresented by: Indah Dwi Pratiwi
Presented by: Indah Dwi Pratiwi Normal Fluid Requirements Resuscitation Fluids Goals of Resuscitation Maintain normal body temperature In most cases, elevate the feet and legs above the level of the heart
More informationSHOCK AETIOLOGY OF SHOCK (1) Inadequate circulating blood volume ) Loss of Autonomic control of the vasculature (3) Impaired cardiac function
SHOCK Shock is a condition in which the metabolic needs of the body are not met because of an inadequate cardiac output. If tissue perfusion can be restored in an expeditious fashion, cellular injury may
More informationBlood Reviews 23 (2009) Contents lists available at ScienceDirect. Blood Reviews. journal homepage:
Blood Reviews 23 (2009) 231 240 Contents lists available at ScienceDirect Blood Reviews journal homepage: www.elsevier.com/locate/blre REVIEW Resuscitation and transfusion principles for traumatic hemorrhagic
More informationShock and Resuscitation: Part II. Patrick M Reilly MD FACS Professor of Surgery
Shock and Resuscitation: Part II Patrick M Reilly MD FACS Professor of Surgery Trauma Patient 1823 / 18 Police Dropoff Torso GSW Lower Midline / Right Buttock Shock This Monday Trauma Patient 1823 / 18
More informationFluid resuscitation in specific patient populations: sepsis and traumatic brain injury
Fluid resuscitation in specific patient populations: sepsis and traumatic brain injury John A Myburgh MBBCh PhD FCICM UNSW Professor of Critical Care Medicine The George Institute for Global Health University
More informationActualités sur le remplissage peropératoire. Philippe Van der Linden MD, PhD
Actualités sur le remplissage peropératoire Philippe Van der Linden MD, PhD Fees for lectures, advisory board and consultancy: Fresenius Kabi GmbH B Braun Medical SA Perioperative Fluid Volume Administration
More informationPrinciples of Fluid Balance
Principles of Fluid Balance I. The Cellular Environment: Fluids and Electrolytes A. Water 1. Total body water (TBW) = 60% of total body weight 2. Fluid Compartments in the Body a. Intracellular Compartment
More information