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ch. 11 Hemorrhage & Hypovolemia (Assessment (化學法 (lactate, >4mM/L…
ch. 11
Hemorrhage & Hypovolemia
body fluid
:pen: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.
#
分類
I, <10ml/kg （15%）
#
II, 10-20ml/kg （15-30%）
systemic vasoconstriction
splanchnic hypoperfusion
III, 20-30ml/kg （30-45%）
hemorrhagic stick
IV, >30ml/kg （>45%）
massive blood loss
Assessment
vital sign
little bevefit
:pen:table 11.2
HCT
無法用來評估失血量（因為失全血）
:red_cross: 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
:<3: DO2=CO×(1.34×[HB]×SaO2）×10
:star: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
從ischemic bowel 來
cytokines
multiorgan failure
no specific therapy
預防
快速矯正缺血
減少crystalloid 和 RBC volume
減少
代償