Treatment
Operative control of blood loss is the major
consideration in patients who have continuing
haemorrhage. In one study, an improvement in outcome
was reported in hypotensive patients with penetrating
torso injuries, when aggressive fluid resuscitation was
delayed until operative intervention had occurred, suggesting that with uncontrolled hemorrhage temporary
or definitive haemostasis (even in the presence of
hypotension) should be performed first, followed by
intravascular fluid replacement. Nonetheless, in the
severely hypotensive trauma patient in whom haemostasis
will be delayed, initial administration of intravenous
fluids will still be required While passive leg raising is sometimes used as a
method to increase central blood volume during
resuscitation, only 100-150 mL are transferred to the
intravascular space by this method.19 Intravenous fluids
including blood, colloid and saline solutions are
administered until blood pressure and peripheral
perfusion are satisfactory or until the PAoP is between
12-18 mmHg.
20,21 Replacement of blood loss in an adult
with colloid or crystalloid solutions (e.g. fresh frozen
plasma, 5% albumin, polygeline, 0.9% saline) will cause
a reduction in the haemoglobin by approximately 1
g/100mL per 500 ml of colloid or crystalloid solution
remaining in the vascular compartment.