Differentiating features between sepsis and trauma are
Patients compensate for volume loss in the early stages of hypovolaemia, so an apparently resuscitated patient may still have a significant volume deficit. The aim for immediate resuscitation should he normal measures of pulse, blood pressure and CVP, urine output > 0.5 mI/kg/hour with normal urinary osmolality and sodium concentration. Any metabolic acidosis should be seen to be correcting. There-after, one must try to maintain normovolaemia. This is a continuous process. Critically ill patients may have capillary leak and will therefore have a continuing colloid requirement. Gelatins, being small molecules, are poorly retained and can be replaced by hydroxyethyl starch, plasma or blood at this stage. In sepsis this requirement may be very large . The impoance of blood in immediate resuscitation, the threshold at which one should transfuse urgently (i.e. con-sider using group compatible, uncross-matched blood or even Group 0 blood) and even the target haemoglobin level are controversial. Resuscitation should not be delayed whilst waiting for blood to be grouped; if acute anaemia is secondary to the bleeding resuscitation should be with Group 0 blood or group-compatible blood as it becomes available. Ref:Surgery of baily and love,26th edition.
Energy requirement
Catabolism
Insulin resistance
Fluid loss
General surgery