Anesthesiologists are involved: Anesthesiologists are involved

Early resuscitation:

• Early resuscitation:

• Fluid administration is the cornerstone of acute resuscitation.

• Intravascular volume is lost because:

• hemorrhage

• uptake by ischemic cells

• extravasation into the interstitial space.

• The ATLS curriculum advocates the rapid infusion of up to 2 L of warmed isotonic crystalloid solution for any hypotensive patient, with the goal of restoring normal BP .

Fluid administration:

• Fluid administration:

• reduces oxygen delivery

• hypothermia

• coagulopathy.

• Elevation of Blood pressure leads to:

• increased bleeding as a result of disruption of clots

• reversal of compensatory vasoconstriction.

• The result of aggressive fluid administration is often a transient rise in BP, followed by increased bleeding and another episode of hypotension, followed by the need for more volume administration.

• This vicious cycle has been recognized since the First World War and remains a complication of resuscitation therapy today.

Application of this technique to the initial management of a hemorrhaging trauma victims highly controversial and has been the focus of numerous laboratory and clinical research efforts.

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