Critical care medicine
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Critical care medicine · Mar 1976
Fluid resuscitation following injury: rationale for the use of balanced salt solutions.
Initial fluid management of the injured patient involves replacement of fluid lost incident to the trauma as well as prompt recognition and treatment of shock. Prompt fluid replacement based on these concepts will result in a reduction in mortality and prevention of many complications resulting from prolonged inadequate tissue perfusion. In this discussion, an attempt will be made to facilitate this approach by: (1) discussing these fluid changes; (2) presenting a clinically applicable classification of shock; and (3) outlining a rational approach to the early treatment of hemorrhagic shock, the most frequent form of shock occurring early after injury.
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The most common bleeding and clotting problems in post-traumatic states are reviewed. The normal response of the coagulation system and the fibrinolytic system to trauma is described; this response must be considered when studying the abnormal situations. The laboratory tests need not be numerous or sophisticated but they must be repeated often enough to understand and interpret the data. A proper understanding of these abnormalities forms the rational basis for the correct choice of therapy, and is of utmost importance in the management of post-traumatic patients.
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The limited variation of pulmonary responses to disease--dyspnea, cough, production of adventitious sounds, sputum production, and hemoptysis--complicates the differential diagnosis of the acutely ill patient with obvious severe pulmonary disease. This paper attempts to reinforce and redefine this problem: acute cardiac and pulmonary dyspnea can generally be separated by quick but careful clinical analysis; mis-diagnosis may lead to disaster since effective treatment of one is frequently harmful to the other.