Risks associated with treating a hypotensive patient with a penetrating chest wound inflicted by a 25cm blade using crystalloid fluids and alternative treatments available in pre-hospital setting
Fluids and venous therapy are still considered as essential elements of pre-hospital life support especially in critically ill patients. The initiation of fluid therapy should be based on clinical assessment in order to avoid the risk of hypovolaemic cardiac arrest during. Crystalloid fluids infusion offers a secure and safe brain through cerebral perfusion pressure. Secure brain function during injuries requires a systolic pressure of above 100mmHg (Søreide & Deakin, 2005). However, those patients’ with severe brain injury are capable of tolerating low blood pressures. In the majority of pre-hospital setting, automated blood pressure gives erroneous values. The ideal pre-hospital fluid regime should combine hypertonic solution given during 10—20 minute’s infusion and crystalloids or artificial colloids.
Researchers argue that the controversy surrounds the usage of crystalloid fluids in balancing tissue oxygen delivery against increasing the blood loss especially to patients with uncontrolled hemorrhage. These fluids are not capable of checking uncontrolled bleeding that occurs in multiple sites. As a result, patients’ are exposed to severe bleeding capable of leading to hypovolaemic cardiac arrest This is trauma resulting from chest wound compromises tissue oxygenation resulting to hemorrhage (Søreide & Deakin, 2005). More importantly, blunt trauma lead to tissue edema, pain, neurogenic factors and spinal injury hence the likelihood of circulatory failure in such patients.
Intravenous fluids can cause haemodilution increment in the extra-cellular fluid compartment. Ideally, researchers argue that the relative expansion of the intravascular volume with 500 ml of an isotonic crystalloid is greater in shocked patients compared to healthy volunteers. Though is vital to raise the systolic pressure especially for the injured brain, there is a high risk of disruption of haemostatic clots in damaged blood vessels resulting to further bleeding (Søreide & Deakin, 2005).
It is also believed that the usage of crystalloid fluids leads to tissue edema, which has the potential of interfering with gaseous exchange in the lungs. Since the establishment of pre-hospital fluid therapy might delay transport and definite medical intervention, such patients are more likely to die before reaching hospitals. Research also indicates that crystalloid fluids increase bacterial translocation in the gut resulting to reduction in capillary blood flow. These effects are fatal given the conditions which prevail in many pre-hospital establishments. According to Søreide and Deakin (2005), the usage of crystalloid fluids in pre-hospital setting raises the possibility if suffering from renal impairment and allergy reaction hence the need to use them with absolute care.
Based on the uncertainties that surround the usage of crystalloid fluids in pre-hospital setting, it is recommended to adopt hypertonic saline. Hypertonic saline osmotic properties attract fluid in the intravascular compartment, and the addition of dextran helps in prolonging this effect by binding to recruited water. Such fluid has been found to improve hemodynamics and rapid adjustment of the blood pressure. Additionally, utilizing artificial oxygen carriers will help in keeping the cardiac output adequate (Søreide & Deakin, 2005). Basically, trauma impairs the oxygen-carrying capacity of the blood affecting brain functioning.
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- Patrick Kimuyu (Author), 2016, Trauma Studies for Paramedics, Munich, GRIN Verlag, https://www.grin.com/document/381304