Anesthesiologists are involved: Anesthesiologists are involved

Sustained ischemia of muscle cells leads to an increase in intracellular sodium and free water with an aggravated depletion of fluid in the vascular and interstitial compartments.

Resuscitation of these patients should be considered in two phase:

• Resuscitation of these patients should be considered in two phase:

• Early, while active bleeding is still ongoing

• Late; once all hemorrhage has been controlled.

• Early resuscitation is much more complex because the risks of aggressive volume replacement summarized in Table 63-6 including the potential for exacerbating hemorrhage and thus prolonging the crisis, must be weighed against the risk of ongoing hypoperfusion.

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