Dịch truyền (crystalloids ví dụ như N / nước muối như dòng đầu tiên) nên được giữ ấm với nhiệt độ cơ thể nếu có thể (ví dụ như prewarm trong xô nước ấm). Hãy nhớ hạ thân nhiệt có thể dẫn đến máu bất thường đông máu. • Tránh các giải pháp có chứa glucose. • | Primary Trauma Care Circulatory Resuscitation Measures See Appendix 5 The goal is to restore oxygen delivery to the tissues. As the usual problem is loss of blood fluid resuscitation must be a priority. Adequate vascular access must be obtained. This requires the insertion of at least two large-bore cannulas 14-16 G . Peripheral cut down may be necessary. Infusion fluids crystalloids . N Saline as first line should be warmed to body temperature if possible . prewarm in bucket of warmed water . Remember hypothermia can lead to abnormal blood clotting. Avoid solutions containing glucose. Take any specimens you need for laboratory and cross matching. Urine Measure urine output as an indicator of circulation reserve. Output should be more than ml kg hr. Unconscious patients may need a urinary catheter if they are persistently shocked. Blood transfusion There may be considerable difficulty in getting blood. Remember possible incompatibility hepatitis B and HIV risks even amongst patient s own family. Blood transfusion must be considered when the patient has persistent haemodynamic instability despite fluid colloid crystalloid infusion. If the typespecific or cross-matched blood is not available type O negative packed red blood cells should be used. Transfusion should however be seriously considered if the haemoglobin level is less than 7 g dl and if the patient is still bleeding. First priority stop bleeding Injuries to the limbs Tourniquets do not work. Besides tourniquets cause reperfusion syndromes and add to the primary injury. The recommended procedure of pressure dressing is an ill-defined entity Severe bleeding from high-energy penetrating injuries and amputation wounds can be controlled by subfascial gauze pack placement plus manual compression on the proximal artery plus a carefully applied compressive dressing of the entire injured limb. Injuries to the chest The most common source of bleeding is chest wall arteries. Immediate in-field placement of .
