Large volume resuscitation
Large volume resuscitation
* Plan for this with every major trauma
* Minimum of 2 large bore IV’s
* Consider insertion of Rapid infusion device
* Choose technique most familiar with
* May need to call for extra expertise
* Choose access appropriate for injury
Eg femoral venous line unsuitable if suspect IVC/hepatic injury
* Use all available resources
* Delegation
* Documentation
* Monitoring
* Communicate with blood bank frequently re blood product availability
* Blood warmer
Fluid resuscitation
* Up to 1 litre blood loss (20% blood volume)
Replace with crystaloid(up to 20ml/kg) then colloid
Check haematocrit
Consider packed cells
* Up to 2.5 litre blood loss (50% blood volume)
Give packed cells
Check coagulation
Consider coagulation factors/platelet Tx
Monitor haematocrit
* Over 2.5 litre blood loss:
Give packed cells urgently
Give coagulation factors/platelet Tx
Check electrolytes
Serial assessments of coagulation/haematocrit/platelet count
* Assess response to fluid resuscitation is important:
Assess effect on peripheral perfusion, HR, Urine output, BP
Response to fluid resuscitation

* Rapid response
< 20 % BV
No further ongoing bleeding
* Transient response
Probably losses are 20 -50% BV
Response to blood may identify those still bleeding & requiring rapid surgical intervention
Minimal or no response to volume resuscitation

* Consider:
Concealed bleeding
Tamponade, tension pneumothorax, embolism
Spinal cord injury
Cardiogenic cause
Age, Medications other Co-morbidities
* Repeat primary survey
* May require urgent surgical intervention