Given immediately in hemorrhagic shock:
Correct Answer: Crystalloids
Description: Ans. (c) CrystalloidsRef: Bailey & Love 26th ed. /16-17* Crystalloid is the first fluid of choice for resuscitation. Immediately administer 2 L of isotonic sodium chloride solution or lactated Ringer's solution in response to shock from blood loss. Fluid administration should continue until the patient's hemodynamics become stabilized. Because crystalloids quickly leak from the vascular space, each liter of fluid expands the blood volume by 20-30%; therefore, 3 L of fluid needs to be administered to raise the intravascular volume by 1 L.* About the use of RL and NS in hemorrhagic shock, it has been shown that Resuscitation with NS modulates hypercoagulability after trauma and results in increased fluid requirements Administration of RL during resuscitation appears to have no effect on the hypercoagulable state induced by trauma. This hypercoagulable state may reduce bleeding and be protective initially, but may lead to thromboembolic complications later in the course of trauma admission. Due to this reason RL may be preferred in the trauma (hemorrhagic shock) in the initial phase over NS.* As the RL is a little hypotonic solution large volume of RL in patients with head injury may lead to cerebral oedema therefore NS may be preferred over LR in patients of hemorrhagic shock with head injury. (Also remember that head injuries may also precipitate hyponatremia. The most common metabolic abnormality after head injury is SLADH).
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