Shock in trauma occurs due to loss of blood from the body. To counter this loss and replenish the lost fluid, blood needs to be transfused in ideal conditions. But blood may not be always available immediately.
Fluids are used to expand the decreased blood volume so that tissue perfusion is maintained. Fluids do not have any capacity to carry oxygen. Only blood has.
There are two types of fluids used for resuscitation-crystalloids and colloids.
Most advocate initiating resuscitation with crystalloid solutions, followed by colloid and blood products based on the severity of hemorrhage.
Crystalloid Solutions
Most crystalloid solutions administered for resuscitation are isotonic with respect to human plasma. Fluids included in this category are Ringer’s lactate solution, normal saline, Isolyte etc. These solutions are easily stored, readily available, and inexpensive.
Crystalloid solutions are usually the first IV solutions administered to the trauma patient for the resuscitation of hypovolemic shock. Although these solutions provide rapid expansion of the intravascular volume, the effects may be temporary because most equilibrate rapidly into the extravascular space.
Larger volumes (up to three times the blood loss) are required to replace hemorrhage when only crystalloid solutions are used. Too much use of these fluids causes complications like edema.
Crystalloid solutions lower the blood viscosity and may improve capillary blood flow.
Colloid Solutions
Colloid solutions include human albumin, Hexastrarch, and dextran. Because they contain larger molecules that do not readily
migrate into the interstitial space, colloid solutions tend to remain relatively intravascular. Colloid solutions expand the intravascular space by increasing the colloid osmotic pressure.
Resuscitation with colloid solution produces a rapid and effective correction of intravascular fluid deficits with less peripheral edema than with crystalloid solutions.
Colloid solutions are used in conjunction with crystalloid solutions to increase blood volume. Like crystalloids they also lack oxygen carrying capacity.
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