A 24-year-old Jehovah's Witness who was in a high-speed motorcycle collision undergoes emergent splenectomy. His estimated blood loss was 1500 mL. Which of the following strategy should be employed for his resuscitation?
Normal saline and lactated Ringer solution are examples of isotonic solutions, both of which can be used to replace the volume of blood lost in a ratio of 3:1. One caveat of administering large volumes of normal saline is that a non-anion-gap metabolic acidosis can result from increased chloride concentrations. Hypotonic saline solutions such as 0.45% normal saline should not be used for acute resuscitation in hemorrhagic shock but are appropriate for postoperative fluid maintenance in the hemodynamically stable patient. The use of colloids in resuscitation of patients in hemorrhagic shock is controversial; in general, however, colloids can be used to replace blood volume lost in a ratio of 1:1. The definitive treatment of hypovolemic shock is fluid resuscitation, not initiation of vasopressors.
Vasopressors should be primarily utilized for maintenance of his blood pressure
Synthetic colloids should be administered as the primary resuscitation fluid in a 3:1 ratio to replace the volume of blood lost
0.9% normal saline should be administered in a 1:1 ratio to replace the volume of blood lost.
Lactated Ringer solution should be administered in a ratio of 3:1 to replace the blood lost.
Preoperative assessment and monitoring in anaesthesia