Delayed-fluid resuscitation Yes/No ?

[Ranjith Ellawala]

I just joined the group from Sri Lanka.
  It is interesting to hear this. 
  How long will it take to start giving blood in this situation?. It takes at least 5 min for uncross match and 25 min for crossmatched RBC. and longer for FFP in our setting. We are dealing with majority of blunt injuries, hence take few min at least to sort out the cavity where bleeding is.To add to the problems we donot have well established Pre hospital ambulance service.
  Thank you
  Ranjith Ellawala
  MBBS; MS; FRCS
  Consultant Surgeon
  Trauma Unit,
  The national hospital of Sri lankla
  Colombo
  Sri lanka

"Sise, Mike MD" <Sise.Mike at scrippshealth.org> wrote:
  Ivan,

We have a protocol at our Level I center for hemorrhagic shock we call "Shock and Awe" (based on the Iraq war lessons). Permissive hypotension, straight to the OR before any fluid infusion, blood 1:1, only enough normal saline to either dilute packed cells for infusion or flush the lines, and placement of the Kimberley Clark warming pads in addition to rapid infuser warmers for the blood. It is not unusual for a patient to receive 10 to 12 units of pRBCs, FFP, platelets and only 2 liters of normal saline. It's amazing how different your approach is when you are not worried about the blood pressure. I'm convinced, in looking back, that we used raising the blood pressure in the trauma room with crystalloids and a small amount of blood as a measure of success rather than focusing on stopping the bleeding and avoiding hemodilution before we had control. I suspect that permissive hypotension is probably as important, if not more important than, avoiding crystalloid, maximizing
 the ratio of pRBCs to FFP and platelets, and avoiding hypothermia. 

However - this is an anecdotal report. "The proof of the pudding is in the tasting" as the saying goes. We need real evidence from appropriate studies to craft the proper way to resuscitate patients. This is, for now, at least a promising, if not yet proven approach.

Mike Sise
San Diego

________________________________

From: Ivan Hronek [mailto:ivanhronek at yahoo.com]
Sent: Tue 5/20/2008 8:58 PM
To: trauma-list at trauma.org
Subject: Delayed-fluid resuscitation Yes/No ?



Question: - is your center practicing the delayed fluid resuscitation in trauma victims ?
- are you a DFR-believer ? Why ?
Ivan Hronek MD 
SFMC, Los Angeles, CA 
http://health.groups.yahoo.com/group/Anesthideas/ Do not fear to be eccentric in opinion, for every opinion now
accepted was once eccentric. - Bertrand Russell-
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