Fluid Resuscitation for Shock

First off… we need to guess roughly how much blood had the patient lost.

Just by looking at few simple things would give you a guide.

  • Blood pressure
  • Pulse rate
  • Mental status

There are other parameters such as respiratory rate and urinary output but the 3 mentioned above are the easiest to assess. They take less time. I like short cuts.

Blood pressure

If blood pressure is within the normal range, estimated blood loss would be about 1.5L or less.

If it is lower than normal, then it is above 1.5L.

Pulse rate

If it is between <100 – 120 beats/min, it is less than 1.5L.

If it is above 120 beats/min, it is above 1.5L.

Mental status

If the patient looks normal with anxiety, it is less than 1.5L.

If the patient is confused and he/she starts scolding your father, mother, girlfriend or boyfriend, it is above 1.5L.

If estimated blood loss is above 1.5L, the patient may need blood transfusion. Get ready packed red blood cells.

Always keep in mind that the patient needs oxygen and glucose to be alive. So make sure the patient is breathing and his circulation is intact.

Make sure at least one large bore cannula is inserted.

Okay. Now you need to decide. Crystalloids or colloids? Make a decision and quick.

I’ll go with 0.9% saline since it’s the safest. Run it as fast as you can. Use your hands to pump the solution bag if it’s not fast enough.

How much to give? It depends. It’s between 1 – 2 litres. In young and healthy adults, 2 litres would be appropriate. In elderly patients, try not to overload their poor poor heart. Try 1 litre first.

Keep an eye on the patient’s blood pressure and pulse rate.

Once the patient’s status is stabilized, treat the cause.

Fluid Therapy for the Needy

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