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3/20/2017 5:03:23 PM
Posted: 9/19/2001 7:18:40 PM EDT
[Last Edit: 9/19/2001 7:27:06 PM EDT by Waldo]
Link Posted: 9/20/2001 5:31:11 AM EDT
Link Posted: 9/20/2001 5:43:45 AM EDT
Out of curiosity, what are blood expanders??? Never heard of them!! What is their purpose? As a filler for a limited amount of lost blood???
Link Posted: 9/20/2001 5:45:45 AM EDT
Waldo, You should check with a local pharmacist, and you`ll probably need a prescription. My advice would be to use either Dextran, Lactated Ringers, or Normosol. I don`t have any experience with Hemabate, but I would stay away from any blood product due to perishablility concerns. I work in a ER and our surgeons seem to prefer these other fluids.
Link Posted: 9/20/2001 6:04:30 AM EDT
[Last Edit: 9/20/2001 6:05:01 AM EDT by Kuiper]
If you're gonna use plasma expanders, make sure your put at least two 500cc bags of Saline in it too. Preferably a couple of large gauge IV canules with adequate fixation material. Our standard procedure for hypovoleamic shock(that's bleeding to death for you nonmedical folks) is the following Start at least two IV's, starting with 1000cc's of Saline. If this won't result in a systolic BP of above 90 mmHg and other 1000 cc of expanders is used. After that Saline is used. Most of the time we wont get to the second Saline part because we work and live within the golden hour of trauma treatment. Oxygen FiO2 100% trough a nonrebreathing mask could be a bit harder to accomplish outside EMS/Emergency ward settings. But nevertheless essential in shocktreatment. It helps oxygenize the remaining Heamoglobulin cells. Saline and plasmaexpanders will do nothing but keeping Kidneyfiltration pressure up until the bleeding is stopped and transfusion is started. So it is absolutely essential to get professional medical aid ASAP. A circulatory problem that you cant get control over is a load and go indication anytime. Disclaimer Non of the above should be attempted by anybody who is not trained in emergency medicine (Either PHTLS/ATLS or BTLS). Subcutan insertion of IV's and the infusion of expanders could result in further damage to the patient. Live by these rules; Treat first what kills first and Do no further damage. Also one of the biggest problems with plasmaexpanders is systhemic allergic reactions, expanding the shock problem into a combination of hypovolemic and anafylactic shock. Kuiper p.s. any EMS/MD personel that knows protocol used Stateside feel free to chime in. As these reflect on our protocols and not necessary on your's
Link Posted: 9/20/2001 6:15:17 AM EDT
Link Posted: 9/20/2001 6:20:55 AM EDT
Link Posted: 9/20/2001 6:35:18 AM EDT
The primary blood expanders that we use in our ICU are 5% albumin and hespan (probably similiar to the hemabate that you mentioned). I am not sure how easy they would be able to get, though.
Link Posted: 9/20/2001 6:45:51 AM EDT
Link Posted: 9/20/2001 6:46:38 AM EDT
Waldo, Under the circumstances of the attacks 11th September any emergency service system how good it may be will be hard pressed. So let's consider normal circumstances, I'd be more focussed in getting transport by land or air into a traumacenter. Most medics/nurses/MD's learn to insert IV's on people that arent in shock. Placing an IV on a patient in shock is a whole different ballgame, due to constriction of arteries(thus limiting the venous return) and redistribution of the circulation(Heart, lungs and brain are prioritized). So consider that if you get it done you're starting treatment in the pre hospital stage. But if you cant get it in, you're wasting space for more experience operators(popped veins are a mess to insert iv's in.) and you're losing your most important ally, time. With all due respect of course for your wife, as I have no idea on how proficient she is with IV's. Kuiper
Link Posted: 9/20/2001 7:00:33 AM EDT
Link Posted: 9/20/2001 7:55:25 AM EDT
Looks like she can hack..... And you're thinking, something the sheeple just won't do. Go with your instinct on this one, you have someone near who can do it. Kuiper
Link Posted: 9/20/2001 8:31:49 AM EDT
[Last Edit: 9/20/2001 8:52:43 AM EDT by Atencio]
Hespan and albumin are very expensive especially albumin. Albumin comes in 5% and 25% usually in 250ml and 50ml respectively. Albumin wont do much unless there is all ready fluid in the body that is 3rd spacing(outside the blood vessels in tissues) The albumin proteins cause a fluid shift that pulls fluid (collidal osmatic pressure)back into the blood vessels. Hespan (Hetastarch) is similar but I think it is a synthetic. For cases of true hypovolemia, find the cause, and like was mentioned give IV normal saline(Lactated ringers if no normal saline around) boluses BTW, there is research going on that suggest that renal failure seen after a cardiac arrest might be caused by all the volume of fluid we pump in and not from the cardiogenic shock.
Link Posted: 9/20/2001 10:37:33 AM EDT
If you find yourself at the point where Hespan is clinically indicated in the middle of nowhere with little hope of transport to medical care, you're kinda pissing into the wind. A trauma/hypovolemic patient needs surgical intervention. For every liter of blood lost you need to replace it with 3 liters of a crystalloid (preferably Ringer's) solution just to match the volume lost. Because of Hespan's(Hetastarch) similarity in osmotic pressure to plasma it remains in the intravascular space longer than any crystalloid solution would. Your still faced with the same problem Kuiper noted. Hemoglobin is not being oxygenated and none of these fluids will carry oxygen like blood does. What you would ideally like to do is let your hypovolemic patient stay in a mild state of shock. This means start the IV, but don't pound them with fluids in an attempt to get the BP above 100. Shock patients that receive large amounts of fluid pre-hospitaly generally have a poorer prognosis/ higher mortality rate than those that do not. If your trying to buy yourself a couple hours it could be useful. I also believe that Hetaspan and other plasma substitutes have some storage issues. Temperature being one of them. Sherm
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