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.
