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