Delayed-fluid resuscitation Yes/No ?

[Timothy Craig Hardcastle]

Juan
 
You also correctly emphasize one vital point - DFR/permissive
hypotension is for NON-COMPRESSIBLE UNCONTROLLED bleeding, not where you
suspect the patient "has bled" and is self limited, nor for where you
can control ongoing haemorrhage with pressure. This latter group is
where you should first "catch-up" and reassess; a good few of them won't
require immediate surgery.
 
And Ivan - Yes, I am a believer, when used for the appropriate patient:
penetrating truncal injury or proximal to mid-thigh, or with blunt
trauma where a vascular injury or major solid organ injury is suspected
in the UNSTABLE and haemodynamically abnormal patient
 
Tim
Dr Timothy C Hardcastle
M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS (SA)
Principal Surgeon-Lecturer / Sub-specialist: Trauma and Critical Care
Deputy director: Trauma Unit and Trauma ICU
Inkosi Albert Luthuli Central Hospital / UKZN
800 Bellair Road
Mayville, Durban
 
Postal: PostNet Suite 27
Private Bag X05
Malvern, 4055
KwaZulu Natal
 
timothyhar at ialch.co.za 
 
-----Original Message-----
From: Duchesne, Juan C [mailto:trauma-list-bounces at trauma.org] On Behalf
Of Duchesne, Juan C 
Sent: 21 May 2008 23:56
To: Trauma & Critical Care mailing list
Subject: RE: Delayed-fluid resuscitation Yes/No ?
 
 
-Are you a DFR-believer ? Why ?
            Ivan-
Yes. 
While hypotensive resuscitation is an integral part of the new strategy
of DCR, the practice itself is not a new concept. Walter Cannon and John
Fraser remarked on it as early as 1918 when serving with the Harvard
Medical Unit in France during World War I. They made the following
observations on patients undergoing fluid resuscitation: "Injection of a
fluid that will increase blood pressure has dangers in itself.
Hemorrhage in a case of shock may not have occurred to a marked degree
because blood pressure has been too low and the flow to scant to
overcome the obstacle offered by the clot. If the pressure is raised
before the surgeon is ready to check any bleeding that may take place,
blood that is sorely needed may be lost." Dr. Cannon's endpoint of
resuscitation prior to definitive hemorrhage control was a systolic
pressure of 70-80 mmHg, using a crystalloid/colloid mixture as his fluid
of choice. Permissive hypotension (restricted fluid resuscitation) and
reduction of crystalloid overload has been shown by the military in Iraq
to increase survival. Although this has not reached standard of care
level, there is enough data to indicate the overly aggressive fluid
crystalloid resuscitation is probably not good. Crystalloid use should
be for maintenance use only.  In the ED, patients with suspected
uncontrolled hemorrhage, resuscitation should be limited to plasma and
blood with immediate surgical intervention. 
Juan
CharityOne
 
  _____  

From: trauma-list-bounces at trauma.org on behalf of Ivan Hronek
Sent: Tue 5/20/2008 10:58 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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