After 30% loss of blood volume in road traffic accident. What next m/n is to be given ?
Ans is 'a' ie. IV Fluids only 30% loss of blood volume is a moderate grade of hypovolemia and can be managed adequately by IV fluids only. Cardiac stimulants, dopamine or vasopressor agents are required only in severe hypovolemia (> 40% loss). Grades of Hypovolemic shock Mild Moderate Severe ( ( 20-40% loss) ( >40% loss) * Cool extremities * Same plus : * Same plus : * Diaphoresis * Tachycardia* * Decrease B.P* * Anxiety * Tachypnea * Marked tachycardia * Increase Capillary refill time * Decrease urine output * Hemodynamic instability * Mental status deterioration Treatment of hypovolemic shock "Initial resucitation requires rapid reexpansion of the cirulating blood volume along with interventions to control ongoing loss. Volume resuscitation is initated with the rapid infusion of isotonic saline or a balanced salt solution such as Ringers lactate through large bore IV lines. No distinct benefit from the use of colloids have been demonstrated and in trauma patients, it is associated with a higher moality. The infusion of 2 to 3 lt. over 20 to 30 min should restore normal hemodynamic parameters. Continued hemodynamic instability implies that shock has not been reversed and/or that there are significant ongoing blood or volume losses. Continued blood loss, with haemoglobin concentration declining to 10 g/dl should initiate blood transfusion. In the presence of severe and for prolonged hypovolemia, inotropic suppo with dopamine vasopressin or dobutamine may be required to maintain adequate ventricular performance, after blood volume has been restored. Infusion of norepinephrine to increase aerial pressure by raising peripheral resistance is inappropriate, other than as a temporizing measure in severe shock while blood volume is reexpanded."
IV fluid only
IV fluid with cardiac stimulant
Dopamine
Vasopressor drug