Cung cấp cho 10-20 ml / kg máu toàn bộ thông qua các lỗ khoan rộng ống hoặc đường tĩnh mạch trung tâm. Tỷ lệ ước tính truyền cho truyền tiếp tục bằng cách sử dụng: • ước lượng máu bị mất • ước tính tiếp tục mất • dấu hiệu quan trọng | 184 POCKET EMERGENCY PAEDIATRIC CARE Following acute severe blood loss when 20-30 of the total blood volume of 80 ml kg is lost and bleeding is continuing - remember Hb can initially be normal Acute blood loss Give 10-20 ml kg of whole blood through wide bore cannula or central venous line. Estimate infusion rate for continuing transfusion using - an estimate of blood lost an estimate of continuing loss vital signs Top-up Transfusion for severe anaemia WHOLE BLOOD 20 ml kg increases Hb by 25 as blood volume 80 ml kg or required volume ml weight kg X 4 X desired rise in Hb g dl . PACKED RED CELLS 15 ml kg or required volume ml weight kg X 3 X desired rise in Hb g dl Blood giving set 15 drops ml Thus mls hour divided by 4 drops min Use a burette in infants or where too rapid infusion could be dangerous incipient or actual heart failure . Commonly available crystalloid fluids Fluid Na mmol l K mmol l Cl - mmol l Energy kcal l Comments Isotonic ciystdlloid fluids Saline 0-9 150 0 150 0 Saline 0-18 dextrose 4 30 0 30 160 Dextrose 5 0 0 0 200 278 mosm l Hartmann s Sõlutrõn Ringer s lastate 131 5 111 0 Lactate 29 mmol l Hypertonic ciystdlloid solutions Saline 0-45 dextrose 5 75 0 75 200 Calcium 2 mmol l Dextrose 10 0 0 0 400 555 mosm l Commonly available colloid fluids Colloid solutions Na mmol l K mmol l Ca mmol l Duration of action hours Comments Albumin 4-5 150 1 0 6 Protein buffers Gelofusin 154 1 1 3 Gelatine Haemaccel 145 5 12-5 3 Gelatine Pentastarch 154 0 0 7 Hydroxyethyl starch 186 POCKET EMERGENCY PAEDIATRIC CARE Some useful information 1. Percentage solution grams in 100 ml . 10 dextrose 10 g in 100 ml 2. 30 NaCl 0-9 NaCl 15 KCl 5 mmol ml each of Na and Cl 0-154 mmol ml each of Na and Cl 2 mmol ml strong KCl 15 g 100 ml 10 Ca Gluconate 0-225 mmol ml 10 g 100 ml 8-4 NaHCO3 1 mmol Na and HCO3 ml 1 ml h 0-9 saline 3 7 mmol Na in 24 hours 3. Serum Osmolality 2 Na K glucose urea normally 276-295 mosm l FENa fractional excretion of sodium Urinary and plasma sodium
