new_n_lost
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i think its infusion of Crystalloid solutions
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| zigzag
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Actually I just found the answers first Normal Saline 0.9% to normalize BP. Following that Half Normal Saline for Salt Replenishment
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| dr_student
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can we find normal BP(in lying down position) in a pt with hypovolemic shock? plz explain
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| SILVER
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there's no gravitational pull
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| new_n_lost
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zigzag wrote:
Actually I just found the answers first Normal Saline 0.9% to normalize BP. Following that Half Normal Saline for Salt Replenishment
R u sure thats the Rx for Hypovolumia
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| SILVER
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why would goljan say saline?
giving normal saline would only increase the extracellular compartment because NaCl doesn't penetrate the cell membrane, so the vascular compartment would never expand, which is what needs to be done in hypovolemic shock.
plasma or whole blood or dextran in saline would be a better choice because these can penetrate the cell membrane thereby expanding the vascular compartment.
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| unique1
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Guys, why not normal saline ? Any crystelloid like lactated Ringer or normal saline can be given . It will expand the vascular volume , although will stay in circulation for a short time. Crystelloid are cheaper and handy and its not wrong to use them.
Colloids stay for a longer time and are a better choice .
In USMLE question scenario , if both are given as answer choice , we will choose blood or plasma but if colloids or blood are not given as a choice, normal saline will be the right answer.
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| Ig F
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the anser shud be a substance increasing vascular compartment..........and plasma or blood is the best option......
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| drduck
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ALWAYS AND ALWAYS......in case of hypotention.......or anycause of fall in blood pressure......start with 0.9% normal saline....the reason is unless u give a fluid that STAYS in the the PLASMA.....there wont be any rise in B.P,
remember blood pressure is the pressure in vascular compartment of body....specifically the arteries...
so the ideal fluid to raise the blood pressure initially will be nothing but an isotonic solution that doesnt move quickly from the vascular compartment....and 0.9% normal saline is the nearest one.
once the blood pressure is normalise try and find out the cause like, check the electrolytes and proteins...and administer the appropriate fluid.
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| SILVER
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drduck wrote:
ALWAYS AND ALWAYS......in case of hypotention.......or anycause of fall in blood pressure......start with 0.9% normal saline....the reason is unless u give a fluid that STAYS in the the PLASMA.....there wont be any rise in B.P,
remember blood pressure is the pressure in vascular compartment of body....specifically the arteries...
so the ideal fluid to raise the blood pressure initially will be nothing but an isotonic solution that doesnt move quickly from the vascular compartment....and 0.9% normal saline is the nearest one.
once the blood pressure is normalise try and find out the cause like, check the electrolytes and proteins...and administer the appropriate fluid.
Reference??
If saline is given, most of it ends up going into the interstitial fluid compartment and not much into vascular compartment. The patient is in shock, meaning there has been considerable blood loss, so doesn't it make sense to expand the vascular compartment? and that too by a substance that can easily penetrate the capillary membrane such as plasma, whole blood, or dextran in saline
Edited by silver on 06/18/07 - 08:32 AM
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| drduck
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it really depends upon what u want to achive....
as per ABC of resuscitation....term C stands for maintainance of circulation....ur target is not to think about to maintain patients intravascular compartment...or what is the cause of the shock....
how much blood is lost or the level of compromise...
ur job is to MAINTAIN THE CIRCULATION, that is maintain the vascular compartant to a level where the body can withstand the amount of damage done by various elements like hypoxia, electrolye imbalance...
u have to reconstitute the fluid in vascular compartment so that there is no increase viscosity in blood....an optimum blood prssure ensures u that there is proper oxygenation to the brain, heart and liver.
ur target is not to ensure that his Hb level is normal or not....
body knows that better than us and has mechanisms to deal with that likeshifting he O2 disso curve, incresing the TIBC, increase in heart rate...and many more....
once there is adequate blood pressure....u now have plentyful of time to think about how to manage further...
reference is goljan....but have done this quite often in my casuality postings....there is specific protocol for every patient,
which is............ ABC....
maintaining circulation is most important rest all shoud to be after it.
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| SILVER
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drduck,
thanks for your explanation. i also started reading into it and learned more about the management of hypovolemia. yeah as you mentioned, main concern is to build up the BP initially and for that saline is what you go for. most of the fluid despite being taken up by interstitial compartment will throw it into the vascular compartment when the body is in such a state (hypovolemic shock)--thereby ultimately expanding the vascular compartment and also building up the BP.
found a good link:- http://www.emedicine.com/emerg/topic532.htm
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| drduck
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thanks to u...silver, as even i had a good revision....
plz go thru goljan audio...once if u havent..
he has took atleast 15 to 20 mins explaing and making students understand this concept....
i also read it yesterday only.....even i knew this thing.....i felt i was so much untouched by many more nice and intresting concepts...
goljan is simply great.....
donno what books did he read
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| arlete
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In the pratice: Normal saline and putting the patient legs up helps A LOT to increase BP.
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