Question

Explain how to approach fluid resuscitation in the trauma patient. Discuss how and why your approach might differ if the patient is geriatric. Explain what comorbidities you must consider when resuscitating, and why. Identify when you would choose normal saline vs. lactated Ringer's solution vs. blood for fluid resuscitation. Provide a rationale for using each of these options.

Answer 1

Fluid resuscitation of trauma patients has been an ongoing challenge, constantly reviewed and debated, resulting in recommendations changing for the use of crystalloids/colloids/packed red blood cells/warm fresh whole blood and clotting factors. Other challenges, such as limited resources, impact the practitioners’ choice of fluid—the best fluid available does not always equate to the best fluid for the patient, especially where long transfers and no blood availability are concerned. These decisions and management strategies appear relevant for further discussion and research, as this fluid resuscitation attempts to provide adequate organ perfusion and oxygen delivery in a system compromised by the physiological consequences of injury. Several questions have arisen from this topic: Which fluid is best, how much should be given, and do specific injuries call for different strategies (Achieving balance in the resuscitation period is challenging, particularly the volume administered. More fluid is not always better, in fact, quite the contrary. Much of the literature on fluid resuscitation focuses on critically ill patients with sepsis, or elective perioperative patients. Small cohorts of trauma patients can be found in the larger studies, but it should be remembered that most of these data include patients from the ICU setting Extrapolation of data to the initial resuscitation phase of the trauma patient is not possible . This article emphasizes different types of fluid available, when they should be used, and recommendations on how to tailor fluid resuscitation through monitoring techniques. The goals of improving physiology, restoring or maintaining normothermia and minimizing coagulopathy should be considered paramount throughout the discussion

Preferably, a balanced salt solution should be used (such as Ringer's lactate or PlasmaLyte); however, care should be taken not to mix this fluid with blood transfusions. When using clear fluids in resuscitation, vigilance is required to provide only that fluid which is necessary to maintain perfusion

#Special patients with special guidance for CPR are considered to be the patients with severe comorbidities: asthma, heart failure with ventricular assist devices, neurological disease, obesity and those with specific physiological conditions (pregnancy, elderly people

# While saline and lactated Ringer’s solution have a few similarities, they also have differences. This can make the use of one more suitable than the other depending on the situation.

Normal saline and lactated Ringer’s are two IV fluids commonly used in hospital and healthcare settings.

They’re both isotonic fluids. Being isotonic means the fluids have the same osmotic pressure as blood. Osmotic pressure is a measurement of the balance of solutes (such as sodium, calcium, and chloride) to solvents

Being isotonic also means that when you get IV lactated Ringer’s, the solution won’t cause cells to shrink or get bigger. Instead, the solution will increase the fluid volume in your body.

Lactated Ringer’s doesn’t mix well with some IV solutions. Pharmacies instead mix normal saline with the following IV solutions:

methylprednisone

nitroglycerin

nitroprusside

norepinephrine

propanolol

Because lactated Ringer’s has calcium in it, some doctors don’t recommend using it when a person gets a blood transfusion. The extra calcium could bind with the preservatives added to blood by blood banks for storage. This potentially increases the risk of blood clots.

As a side note, lactated Ringer’s is also slightly different from what’s called simply Ringer’s solution. Ringer’s solution usually has sodium bicarbonate instead of sodium lactate in it. Sometimes Ringer’s solution also has more glucose in it than lactated Ringer’s

Lactated Ringer’s solution has a lot of the same electrolytes that blood naturally does.

one of the companies that manufactures lactated Ringer’s, every 100 milliliters of their solution includes the following:

calcium chloride: 0.02 grams

potassium chloride: 0.03 grams

sodium chloride: 0.6 grams

sodium lactate: 0.31 grams

water

Both adults and children can receive lactated Ringer’s solution. Some of the reasons why a person may get this IV solution include:

to treat dehydration

to facilitate the flow of IV medication during surgery

to restore fluid balance after significant blood loss or burns

to keep a vein with an IV catheter open

Lactated Ringer’s is often the IV solution of choice if you have sepsis or an infection so severe your body’s acid-base balance is thrown off.