ch. 11
Hemorrhage & Hypovolemia

body fluid
🖊table 11.1

extra vas.
interstitial fluid
75%

intra vas.
plasma
25%

blood loss

response I
transcapillary refill
(間質流到血漿)

interstitial fluid defict

response II
RAA sys. #

減少

分類

I, <10ml/kg (15%) #

II, 10-20ml/kg (15-30%)

III, 20-30ml/kg (30-45%)

IV, >30ml/kg (>45%)

systemic vasoconstriction

splanchnic hypoperfusion

hemorrhagic stick

massive blood loss

代償

Assessment

vital sign

little bevefit
🖊table 11.2

HCT

無法用來評估失血量(因為失全血)

❌ 不要用CVP

化學法

lactate, >4mM/L 不好

lactate clearance, <24hr to normal 佳

Fluid response

fluid challenge
10-15mins 給予500ml isotonic saline

用doppler 測CO
上升12-15%

passive leg raising 45°

當限水時可以用

不建議腹內壓高的病人

semiautomated blood volume analyzer

infusion fluid

短,大號周邊line佳

pRBC

Resuscitation
❤ DO2=CO×(1.34×[HB]×SaO2)×10

⭐CO

pRBC不佳

colloid fluid 佳
❗table11.3

但臨床上仍然用
crystalloid fluid

lactate Ringer

Damage control resuscitation
(massive blood loss)

Hypotensive resuscitation

Hemostatic resuscitation

FFP , platelet
給得更頻繁

post resscitation injury
48-72hrs

reperfusion injury

no specific therapy

預防

快速矯正缺血

減少crystalloid 和 RBC volume

從ischemic bowel 來

cytokines

multiorgan failure