Would you push fluids or not?

[MSDeltaFlt]

Mostly I agree with what Arizona said. The Med Control was treating the symptoms moreso than the numbers. Plus you gotta think. Is a liter of fluid really that much fluid on an adult? He lost a liter and a half of blood in the truck. Blood is three times thicker than isotonic fluid. Running one bag in, MAYBE 2, is not unlike spitting in the ocean. It won't hurt him.

Were there any adverse effects of only 200cc in? More than likely not.

While writing this post I've been thinking. You ever wonder why MD's stand by the wall of the ER room when a pt is rolled in as they are giving orders? One reason is keep out of the way of us subordinates doing our work following their orders. The other is maybe they are taking in the "Big Picture" of what's going on.

Big picture here? Treat the symptoms. Run the bag in.

Humbly written

[Kaisu]

I would say permissive hypotension is not called for here. It is geared more towards acute bleeds that are traumatic in origin, although there are other applications.

OK - this I will buy. The doc took a reasonable position. Thank you so much for all your answers. BTW - the patient died in the ER.

[crotchitymedic1986]

well then, i would schedule some training for those medics, because they obviously didnt know the signs and symptoms of someone who was bleeding to death.

[MSDeltaFlt]

Were there any adverse effects of only 200cc in? More than likely not.

I stand corrected.

[crotchitymedic1986]

yes delta, it is nice to have all the information.

[ncmedic309]

OK - this I will buy. The doc took a reasonable position. Thank you so much for all your answers. BTW - the patient died in the ER.

That blows...

[Kaisu]

Doc figured the guy would have died with 2 liters in him. Nothing would have helped in this specific instance. I just wanted to know what the right thing to do would have been in general.

[crotchitymedic1986]

Without seeing the patient it is hard to say, but since he died i am guessing he wasnt A&O with great color and vital signs. As one of the previous posters stated, it takes 3cc of fluid to replace 1cc of blood and you stated there was atleast 1500 cc lost (I missed that during my first read of your post). If he was alert, then orthostatic vital signs might have painted a better picture for you -- if he was altered, they should have been much more aggressive. I dont remember reading about your "scene" times, only that you had a short transport time. I probably would have ran in 1000-1500 via pressure bag or pump with that much blood loss, and then reevalutated the patient. If no one has told you -- the bowel movement in your pants is an ominous sign in healthy adults (not nursing home pts persae) that cardiac arrest is near. Does it always mean they are going to die -no, but it should get your attention.

[HellsBells]

well then, i would schedule some training for those medics, because they obviously didnt know the signs and symptoms of someone who was bleeding to death.

That is not something you can judge by a messege on a forum. He could have been been compensating right up to the time he was dropped off at the ER, then started to circle the drain.

In my opinion the paramedics gave reasonable care, they got two lines and hurried to the hospital. What this man needs is surgical intervention. Sure they could have pressure infused more fluid into him, but maybe they placed the IV's enroute and were at the ER before they had time to infuse a litre or two.

However, a good history would give clues on the pts condition. Did he have HTN? Was he on Beta Blockers? How long had he been bleeding? There are a lot more factors here than simply BP, pulse and amount of fluid.

[Kaisu]

We all know that we need to treat the patient. Presentation, history, etc. are critical. I was trying to get a handle on what appeared to be a blanket statement by the medical director. The information I related to you was what was provided at the run review. I had a lot of questions after it and the type of discussion this has generated on this site was what I was looking for at the review. Thank you all for contributing. As a scared, inexperienced newbie thrown to the wolves, I have to stop trying to come up with a few simple "rules" about patient care and continue to try and learn and keep thinking. Thanks again.