Of course, Scotch is a colloid
In discussing blood pressures, and fluid resuscitation, my current precept asked a simple question, “When would you use crystalloids over colloids, assuming both were available?”. Further discussion led to a narrowing of the question to, “When would you use crystalloids and pressors, rather than simply switching to colloids?”
Since there are a variety of reasons to use any fluid resuscitation, let’s make this a trauma patient. Mr. Smith was using his chainsaw to remove a fallen tree on his property when – whoops! – chainsaw slips and he has a deep cut on his anterior thigh. EMS arrives, bleeding is controlled to an oozing wound. Mr. Smith is ashen, tachycardic and hypotensive. The nearest ED is a 20-minute response.
Now, to understand why the precept posed this question, you need to know that it takes far less of a colloid solution to produce the same effect on blood pressure as lots of crystalloid. Generally, 250ml of colloid has the same BP effect as 4 liters of crystalloid. That is, 1/16th the amount of colloids does the work of crystalloids.
“What!” you exclaim. “DTs, this means that… hmmm, 4/4 = 1 liter, therefore 250/4 = 62.5… this means that instead of hanging a liter of saline wide open to raise a blood pressure, I can draw up a 50ml syringe of this ‘colloid’ of which you speak and bolus a nice big systolic BP almost immediately! Why, this revolutionizes EMS! A ...
Source: DTsEMT - Category: Ambulance Crew Authors: dtsemt Tags: Learning Curve Source Type: blogs
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