Fluid Resuscitation
Aggressive fluid resuscitation without adequate haemostasis has been demonstrated to dilute clotting factors and potentially dislodge clots. Maintaining a normal blood pressure may worsen bleeding. If there is ongoing and brisk bleeding, it may be impossible to adequately resuscitate a patient until the tap is switched off.
Examples of this situation would be a significant liver and spleen injury, or injury to one of the large intra-abdominal vessels. Continued fluid administration in this setting will eventually serve to haemodilute and impair coagulation. Immediate CT should be carried out and transfer from there to the angiographic suite if available or operating theatre depending on findings.
Table 1 outlines general guidelines for establishing the amount of fluid and blood likely required during resuscitation. If the amount of fluid required to restore or maintain adequate organ perfusion and tissue oxygenation greatly exceeds these estimates, carefully reassess the situation and search for unrecognized injuries and other causes of shock.
Table 1 responses to initial fluid resuscitation
| RAPID RESPONSE | TRANSIENT RESPONSE | MINIMAL OR NO RESPONSE | |
| Vital signs | Return to normal | Transient improvement, recurrence of decreased blood pressure and increased heart rate | Remain abnormal |
| Estimated blood loss | Minimal (<15 % ) | Moderate and ongoing (15%40%) | Severe (>40%) |
| Need for blood | Low | Moderate to high | Immediate |
| Blood preparation | Type and crossmatch | Type-specific | Emergency blood release |
| Need for operative intervention | Possibly | Likely | Highly likely |
| Early presence of surgeon | Yes | Yes | Yes |
Learning Bite
Continuing abnormal physiology despite aggressive fluid resuscitation mandates early surgical intervention to turn off the tap.