Page 1 of 1: surg:In shock due to severe skin burn it would be most physi

BRAVO · Credits: 46015 My Scrapbook

In shock due to severe skin burn it would be most physiological to give:

1)packed cells
2)platelets
3)whole blood
4)plasma

drlouis · Credits: 5374 My Scrapbook

PLASMA--BECAUSE OF CAPILLARY LEAK

At an emergency facility, immediate care includes establishing an adequate airway, stopping the burning process, replacing lost fluid (plasma), recognizing and managing associated life-threatening major trauma, diagnosing metabolic abnormalities, assessing the possibility of bacterial infection from contamination before admission, and protecting the patient from further bacterial contamination.

Alterations in microvascular permeability are a hallmark of a number of inflammatory conditions including sepsis, septic shock, burns and the acute respiratory distress syndrome. As a result, the loss of plasma fluid into the interstitial space leads to hypovolaemia and tissue hypoperfusion. Administration of large volumes of fluids in often necessary to restore the nutritional blood flow to tissues. This strategy, however, involves the risk of interstitial edema formation, which in turn may further impair tissue oxygen distribution. The presented paper briefly reviews the principles of transvascular fluid exchange and the pathophysiology of capillary permeability. It discusses the ongoing controversy on the optimal way and the end points of volume replacement as well as the choice of fluid in conditions associated with capillary leakage.(Cas Lek Cesk. 2002 Aug 30;141(17):540-5.)

There is no evidence from randomised controlled trials that resuscitation with colloids reduces the risk of death, compared to resuscitation with crystalloids, in patients with trauma, burns or following surgery. As colloids are not associated with an improvement in survival, and as they are more expensive than crystalloids, it is hard to see how their continued use in these patients can be justified outside the context of randomised controlled trials.(Cochrane Database Syst Rev. 2004 Oct 18;(4):CD000567.)

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