This document discusses fluid management in burn patients. It provides guidelines for calculating fluid needs based on the percentage of total body surface area burned. For a 30-year-old male with 36% burns to the thighs and buttocks, the recommended intravenous fluid is Ringer's lactate given at 4 ml per kg per percentage of burns per 24 hours. It also discusses various formulas for fluid resuscitation in adults and pediatrics. Complications of burns and inhalation injuries are outlined along with principles of wound management and prevention of contractures.

2. FLUID MANAGEMENT IN BURNS AND SHOCK
Dr. D. Padmaraju
Prof. Santhaseelan – S6 unit
PANEL DISCUSSION

3. Case:
30 year old male (weight - 50 kg) has 2nd degree burn injury of both thighs and
buttocks. How will you calculate the percentage of burns?
Wallace rule of 9 - 36%

4. What is the indication for giving IV fluids in burn injury?
What is the IV fluid of choice in adult and pediatric patient with burn injury ?
RL
Adult
15%

5. How will you calculate the dose of IV fluids in this patient? And how will you give ?
Volume of RL/day = 4ml x %BSA x weight
4x36x50=7200ml
½ - 8h = 3600 ml
1min = 112.5 drops (volxdrops/ml)/(hx60)
½ - 16h = 3600 ml
1min = 56.25 drop

6. What are the other formulas for giving IV fluids ?
Crystalloids – Parkland, Modified Brooke
Colloids – Evans, Brooke, Slater
Hypertonic saline – Monafo, Warden
Dextran - Demling

7. Case:
50 year old male was sleeping in the bed under the influence of alcohol after
quarrelling with his wife. His wife poured kerosene over his body and burned
him. He was brought to the casualty. On examination he had 2nd degree burns in
the back.
what is the zone of burn injury in the area C?
Name the model used in the burn injury?

8. What is the indication for referral to higher center ?
Partial / full thickness burns in adults > 10% TBSA
Partial / full thickness burns in children > 5% TBSA
Burns to the face, hands, feet, genitalia, perineum and major joints
Chemical burns
Electrical burns
Burns with concomitant trauma
Burns in patients with pre existing medical conditions that could
adversely affect patient care and outcome
Children with suspected non accidental injury
Pregnancy with cutaneous burns

9. What are all the Indications for admission in burn injury patient ?
Any moderate (>15%) and severe burns
Suspected airway or inhalation injury
Any burn likely to require fluid resuscitation
Any burn likely to require surgery
Hand, face, feet or perineum
Burns in extremes of age
All electrical/deep chemical burns
Any suspicious of non accidental injury
Patients whose psychiatric or social background makes it inadvisable to send them
home
Any burn with associated potentially serious sequelae, high tension electrical burns
and concentrated Hydrofluoric acid burns

10. Case:
11 year old baby developed 2nd degree burns
in the both upper limb, chest and abdomen.
How will you calculate burn surface area in
paediatric age group ?
13+1 ½+ 1 ½ + 2 + 1 ½+ 1 ½ + 2 = 23%

12. What is the dose of IV fluids in this child ?
Parkland formula = 4 x age x % BSA
4x23x11 = 1012 ml
½ = 8h = 506 ml = 63.25 drops/min
½ = 16h = 506 ml = 31.63 drops/min

13. How will you calculate the maintenance IV fluids dose?
What is the maintenance IV fluid of choice in children?
5% DNS
Isolyte P
What is the end point of resuscitation ?
Target urine output is 1-1.5 ml/kg/h (child)
30-50 ml/h (adult)

14. What is the size of venflon used for giving IV fluids during resuscitation ?
16Fr – Grey colour
When will you use two venflon for resuscitation for burn injury patient ?
Burns > 40% - 2 large bore iv cannula
What is the colour coding for venflon ?

15. Where to put venflon in a burn patient involving both upper limb and lower limb ?
Over the burn site
Central venous access
Intro osseous access
Venous cut down

16. What are the types of burns
Place your scary screenshot here

17. How will you classify burn injury based on
percentage of burns?
Mild Moderate Severe
Partial thickness burns < 15% in
adult (<10% in children)
Full thickness burns less than 2%.
Can be treated on outpatient basis
Second degree of 15-25% burns
(10-20% in children)
Third degree between 2-10% burns
Second degree burns more than
25% in adults(children
more than 20%)
All third degree burns of > 10%
Burns involving eyes, ears, feet,
hands, perineum
All inhalation and electrical burns
Burns with fractures or major
mechanical trauma

18. Case:
41 year old male patient developed burn injury in the back, what is the degree of
burns?
First degree burn
Here the epidermis looks red and painful, no blisters
Heals rapidly in 5-7 days by epithelialization
without scarring

19. 55 year old male brought to the casualty with allegsed H/O accidental scald burn in
the right lower limb. What is the degree of burn in this case?
Second degree burn
The affected area is mottled, red, painful, with blisters
Heals by epithelialisation in 14-21 days
Superficial second degree burn heals causing pigmentation
Deep second degree burn heals, causing scarring and pigmentation

20. Third degree
The affected area is charred, parchment like, painless and insensitive, with
thrombosis of superficial vessels
It requires grafting. Charred, denatured, insensitive, contracted full thickness burn
is called as eschar
Fourth degree – involvement of muscles and bones

21. Altered
hemodynamics
Immunosuppression
Decreased renal
blood flow
Vascular permeability
increased
Oedema
Hypermetabolism
Increased gut
mucosal permeability
What is the pathophysiology of burn injury?

22. How will you manages burn injury patient ?
First Aid
Stop the burning process and keep the patient away from the burning area
Clothing should be removed
Cool the area with tap water by continuous irrigation for 20 minutes (cold water -
hypothermia)
Chemoprophylaxis—tetanus toxoid; antibiotics; local antiseptics
Covering with dressings by different methods
Sedation, analgesics & PPI

23. Definitive Treatment
Patient should be in burns unit (ideally air-conditioned) with barrier nursing, sterile
clothes, bed sheets with all aseptic methods
Assess the percentage, degree, and type of burn
Fluid resuscitation
Ringer lactate is the fluid of choice
Blood is transfused in later period (after 48 hours)
After 24 hours up to 30-48 hours, colloids should be given to compensate plasma
loss

24. Urinary catheterization, Ryle’s tube insertion
Total parenteral nutrition
Intensive nursing care
Monitoring the patient - Hourly pulse, BP, PO2, PCO2, electrolyte analysis, blood
urea, nasal oxygen
Antibiotics - Penicillins, aminoglycosides, cephalosporins, metronidazole
Culture of the discharge - total white cell count and platelet count at regular
intervals

25. Local Management
What are the dressing materials available for burn wound?
Paraffin gauze
Hydrocolloids
Plastic films
Vaseline impregnated gauze
Fenestrated silicone sheet
Biological dressings like amniotic membrane
Synthetic biobrane
Closed method - reduce the pain and act as an absorbent
Open method – head and neck

26. What is this procedure known as ?
Tangential excision of burn wound
When it is done ?
Done within 48 hours in patients with less than 25% burns. It is usually done in deep dermal burn
wherein dead dermis is removed layer by layer until fresh bleeding occurs. Later skin grafting is
done.
What is the advantages of this procedure?
It reduces the chance of secondary infection
Reduces formation of hypertrophic scar or contracture

27. What are the ointments available for burn wound management?
Silver sulfadiazine 1%
Mafenide acetate 5%, 11%
Silver nitrate 0.5%
Povidone iodine 5%
Silver sulphadiazine and cerium nitrate
What are the contraindications for using Silver sulfadiazine 1% ointment?
Pregnancy, lactation, child <2years
What is the side effect of using Mafenide acetate 5%, 11% ?
Metabolic acidosis
Which ointment will boosts cell mediated immunity and forms sterile eschar?
Silver sulphadiazine and cerium nitrate?

28. When skin grafting is done for burn wound?
Once the area granulates well, in 3 weeks
usually, split skin grafting is done
What is the indication for cultured skin?
Useful in burns of > 80%.

29. Place your
screenshot here Place your screenshot here

30. Synthetic dressing
What is this ?
Vaseline impregnated gauze dressing - prevents stiffness of Eschar
Name one advantage for Hydrocolloid dressing (duoderm).
Stimulates epithelialisation

31. Opsite
Biobrane

32. Integra
Contains deeper collagen matrix as dermal substitute
outer silicone sheet as epidermal substitute, is removed 2 weeks after dressing and
additional autograft should be placed.
Scarring after healing is reduced significantly

33. What is Eschar?
It is charred, denatured, full thickness, deep burns with contracted dermis.
Complication of Eschar ?
Circumferential eschar – compartment syndrome
How will you treat Eschar?
Escharotomy
Avoid injury to major neurovascular system
Eventually eschar should be excised and the area is allowed to granulate and skin
grafting should be done

36. What are all the complications of Burns Contracture?
Eye - Ectropion of eyelid - keratitis and corneal ulcer
Face - Disfigurement
Mouth - microstomia
Neck - restricted movements
Joints - Disability and nonfunctioning
Skin - Hypertrophic scar and keloid formation
Repeated breaking of scar and infection, ulcer, cellulitis
Pain and tenderness in the scar contracture
Marjolin’s ulcer
Place your scary screenshot here

37. What is tissue expansion surgery?
Scar reconstruction

38. What is the treatment for Contracture ?
skin graft or “Z” plasty or different flaps
How can we prevent development of contracture?
Joint exercise in full range during recovery period of burns
Pressure garments for a long period
Topical silicon sheeting
Saline expanders for scars
What is the treatment for itching in burn scar?
Aloe vera, antihistamines and moisturizing creams

39. Case:
30 year old male presented with accidental burn injury of the face and head and neck,
with sPo2- 80. How will you calculate the percentage of burn?
9%
How will you manage this patient?
Open method with application of silver sulfadiazine without any dressings

40. How will you manage this case?
Hyperbaric oxygen
Ventilator support for several weeks.
Tracheostomy whenever required
Antibiotics.
Bronchoscopy, at regular intervals to remove bronchial cast.
IV heparin to reduce bronchial cast.
Heparin nebulization (10,000 units in 3 ml saline 4th hourly)
N-acetylcysteine nebulisation—20% in 3 ml saline 4th hourly
Bronchodilators like albuterol 2nd hourly
Hypertonic saline inhalation induces the effective coughing to remove casts.
Racemic epinephrine is used to reduce mucosal oedema
Monitoring the patient with arterial blood gas analysis regularly

41. Carbum sputum
Change in voice
Singed facial and nasal hair
Decreased level of consciousnes
Stridor and dyspnoea
When will you suspect inhalation injury ? What are the symptoms and signs?

42. What are the symptoms of carbon monoxide intoxication ?
Headache, disorientation, visual changes, fatigue, vomiting, hallucinations, shock
and cardiac arrest.
Pathophysiology of inhalation injury?
CO poisoning
Hydrocyanide - causes tissue hypoxia and profound acidosis
Laryngeal oedema and laryngospasm
Bronchial oedema and bronchospasm
Formation of bronchial cast is typical which is due to oedema, lymph exudation,
separation of ciliated epithelial cells from basement membrane
Inhaled gas causes supraglottic airway burn, laryngeal oedema, loss of respiratory
epithelium, ARDS, CO poisoning, mechanical restriction of chest wall
movement.

43. Complications of inhalation injury

44. Case:
25 year old male developed accidental burn injury of the hand as shown in the
figure. What is the percentage of burn injury?
1%

45. How will you classify IV fluids?
IV fluids
Blood and
blood products
Non blood IV
fluids
Colloids
Crystalloids

46. How will you classify crystalloids?
Crystalloids
Hypotonic solution
5% dextrose
0.45% NS
Isotonic solution
NS
RL
Plasmalyte
Hpertonic solution
5% Dextrose
10% Dextrose
25% Dextrose
Hypertonic saline
Mannitol
Crystalloids
Ionic solution
NS
DNS
RL
Non ionic solution
5% Dextrose
25% Dextrose

47. How will you classify colloids ?
Natural
FFP
Albumin – 5%, 20%, 25%
Plasma proteins
Artificial
Dextran – 6%, 10%
Gelatin polymers (hemaccel)
Hydroxyethyl starch – 6%, 10%
Heta starch
Hexa starch
Penta starch
Tetra staarch
z

48. Proteinous
Gelatin
Hemaccel
Gelofusin
Albumin
Non proteinous
Starch
HES
Heta starch
Hexa starch
Penta starch
Tetra starch
Dextrans – 6%, 10%

49. How will you classify blood and blood
products?
Whole blood
Packed Red Blood Cells (PRBS)
FFP – plasma proteins
coagulation factors
protein C,S
antithrombin
Platelet concentrate
Cryoprecipitate – cold insoluble plasma proteins
Fibrinogen
Factor VIII
vWF

50. What is the Ideal replacement fluid ?
NS
What is the Ideal maintenance fluid ?
5% Dextrose + 0.45 % Normal saline
Ideal post operative maintenance fluid ?
NS – first POD
5% Dextrose + 0.45 % Normal saline – from 2nd POD

51. What is the composition of RL?
Dextrose Na K Cl Acetate Lactate NH4Cl Ca Mg HPO4 Citrate mOsm/L
5% Dextrose 50 - - - - - - - - - - 252
0.9 % Saline - 154 - 154 - - - - - - - 278
D 5% 0.45% NS 50 77 - 77 - - - - - - - 308
DNS 50 154 - 154 - - - - - - - 432
RL - 130 4 109 - 28 - 3 - - - 586
ISOLYTE G 50 63 17 150 - - 70 - - - - 274
ISOLYTE M 50 40 35 40 20 - - - - 15 - 580
ISOLYTE P 50 25 20 22 23 - - - - 3 3 410
ISOLYTE E 50 140 10 100 47 - - 5 3 - 8 368

53. A

55. What is this ?
IV set
It is made up of?
PVC
How it is sterilized?
Ehylene oxide sterilisation

56. What is crystalloids ?
Electrolyte solutions with small molecules that can diffuse freely from intravascular
to interstitial fluid compartments.
What is colloids ?
Saline solution with large solute molecules that do not pass readily from plasma to
interstitial fluid

57. What is the difference between crystalloids
and colloids

58. 0.9% SALINE/NORMAL SALINE/PHYSIOLOGICAL SALINE/ISOTONIC SALINE
What is the composition of NS?
Na-154 meq/l
Cl- 154 meq/l
pH- 5.7
Pharmacological basis
Provide major extracellular electrolytes.
Corrects both water and electrolyte deficit.
Increase the intravascular volume substantially.
Suppressing the renin-angiotensin-aldosterone axis
Chloride-mediated renal vasoconstriction

59. Indications
To maintain effective blood volume and blood pressure in emergencies
Water and salt depletion – diarrhoea, vomiting, excessive diuresis or excessive
perspiration
Hypovolemic shock- distributed in extracellular space expanding the intravascular
volume.
Ideal fluid to increase blood pressure
Preferred in case of brain injury, hypochloraemic metabolic alkalosis ,
hyponatraemia
Initial fluid therapy in DKA
Fluid challenge in prerenal ARF
Irrigation for washing of body fluids
Vehicle for certain drugs

60. Limitations/ Contraindications
Hypertension, Preeclamsia
Edema due to CCF, renal failure and cirrhosis
In dehydration with severe hypokalaemia – deficit of intracellular potassium –
infusion of NS without additional K+ supplementation can aggravate electrolyte
Imbalance
Large volumes or too rapid administration can cause sodium accumulation and
pulmonary edema
Hyperchloremic metabolic acidosis

61. RINGER'S LACTATE
Composition
Sodium - 131meq/l
Chloride – 111meq/L
Potassium – 5meq/L
Calcium – 2meq/L
Bicarbonate – 29 meq/L
Each 100 ml contains
Sodium lactate - 320mg
NaCl - 600mg
KCl- 40mg
CaCl- 27mg

62. Disadvantage
Presence of ionized calcium in ringer’s lactate can binds to citrated anticoagulant in
stored blood and promote formation of clots
In critically ill patients with impaired lactate clearance due to circulatory shock or hepatic
insufficiency, Ringer’s lactate infusion can increase serum lactate levels
Pharmacological basis
Ringer`s lactate is the most physiological fluid as the electrolyte content is similar to that
of plasma. Larger volumes can be infused without the risk of electrolyte Imbalance
Due to high Na ( 130mEq/L) content RL rapidly expands intravascular volume effective in
treatment of hypovolemia
Sodium lactate in RL is metabolized to bicarbonate in the liver -- useful in correction of
metabolic acidosis

63. Indications
Correction in severe hypovolaemia
Replacing fluid in post operative patients, burns, fractures.
Diarrhea induced hypokalemic metabolic acidosis and hypovolemia.
In DKA , provides glucose free water, correct metabolic acidosis and supplies
potassium
Maintainance fluid during surgery

64. Contraindications
Severe liver disease, severe hypoxia , shock – impaired lactate metabolism –lactic
Acidosis
Addison’s disease
In vomiting or continuous nasogastric aspiration, hypovolemia is associated with
metabolic alkalosis - as RL provides HCO3 - worsens alkalosis
Precautions
Certain drugs – amphotericin, thiopental, ampicillin, doxycycline should not be
mixed with RL – calcium binds with these drugs and reduces bioavailability and
efficiency

65. DEXTROSE SOLUTIONS
D5 water (5%D)
Dextrose with 0.9% NS ( DNS ).
Dextrose with 0.45% NS (D 1/2NS )
10% dextrose
25% dextrose
What is the EFFECT OF DEXTROSE IN FLUID?
Protein sparing effects - limit the breakdown of endogenous proteins to provide
calories
Volume effect - predominant effect is cellular swelling
Lactate production - infused glucose is directed towards lactate formation
Effect of hyperglycemia

66. Disadvantage
It has several deleterious effects in critically ill patients including –
immune suppression
increased risk of infection
aggravation of ischemic brain injury
Hyperglycemia

67. 5 % DEXTROSE
Composition : Glucose 50 gms/L + free water
Pharmacological Basis
Corrects Dehydration And Supplies Energy ( 70kcal/L)
Administered safely at the rate of 0.5gm/kg/hr without causing glycosuria
Indications
Cheapest fluid to provide adequate calories to body –patient on NPO
For pre and post operative fluid management
IV administration of various drugs
Correction of hypernatraemia due to pure water loss ( Diabetes insipidus)

68. Limitations
Neurosurgical procedures - can aggravate Cerebral oedema and increase ICT
Acute ischaemic stroke - hyperglycemia aggravates cerebral ischaemic brain
damage.
Dextrose metabolism aggravates tissue acidosis in ischaemic areas- anerobic
oxidation of glucose produces more lactic acid and free radicals
Hypovolemic shock - Poor expansion of intracellular volume. Faster rate of infusion
causes osmotic diuresis. worsens shock and false impression of the hydration
status
Hyponatremia & water intoxication

69. Hypernatremia – fast infusion of 5D rapidly corrects hypernatremia but correction
occurs slowly in brain cells, so swelling of brain cells can lead to permanent
neurological damage. Moreover rapid infusion of 5D induces osmotic
diuresis which aggravates hypernatremia
Blood and dextrose solutions should not be administered in same IV line –
haemolysis , clumping seen due to hypotonicity of the solution
Uncontrolled DM , severe hyperglycemia

70. DEXTROSE SALINE (DNS)
Composition
Na- 154 mEq/L
CI- 154mEq/L
Glucose- 50 gm/L
Pharmacological basis
DNS is not hypotonic (due to Nacl) and hence it is compatible with blood
transfusion
Indication
Correction of vomiting or nasogastric aspiration induced alkalosis and
hypochloremia along with supply of calories

71. DEXTROSE WITH HALF STRENGTH SALINE (0.45% NS)
Composition
5% dextrose with 0.45% NS
NaCl – 77 meq/L each
Glucose 50 gm/L
Indications
Fluid therapy in paediatric
Treatment of severe hypernatremia – It corrects hypernatremia gently, it
avoids cerebral edema
Maintenance fluid therapy and in early post operative period

72. 10% DEXTROSE & 25% DEXTROSE
Pharmacological basis
It is hypertonic crystalloid fluid
Supplies energy and prevents catabolism useful when faster replacement of
glucose is needed like in Hypoglycemic coma
In patients with fluid restriction- CCF, Cirrhosis and Renal failure
Indications
Rapid correction of hypoglycaemia
In liver disease, if given as first drip, it inhibits glycogenolysis and
gluconeogenesis
Nutrition to patients on maintainance fluid therapy.
Treatment of hyperkalemia with Insulin

73. MANNITOL
Pharmacological basis
Mannitol is an osmotic diuretic that is metabolically inert in humans
Mannitol elevates blood plasma osmolality, resulting in enhanced flow of
water from tissues, including the brain and cerebrospinal fluid, into interstitial
fluid and plasma
As a result cerebral edema, elevated intracranial pressure, and cerebrospinal
fluid volume and pressure may be reduced
Reduction in blood viscosity
Complications
Rebound edema
Dehydration due to osmotic diuresis
Renal failure

74. Limitations
Anuria due to severe renal disease
Cannot be used in patients with hypotension
Severe pulmonary congestion or frank pulmonary edema
Active intracranial bleeding except during craniotomy
Severe dehydration
Progressive renal damage or dysfunction after institution of mannitol therapy,
including increasing oliguria and azotemia

76. Isolyte G
Indications
Vomiting / NGT induced hypochloremic , hypokalemic metabolic alkalosis
Treatment of metabolic alkalosis
Limitations
Hepatic failure, renal failure, metabolic acidosis
Richest source of potassium Which IV fluid is richest source of potassium?
ISOLYTE M (35mEq)
Which isolyte is given for correction of Magnesium deficiency ?
Isolyte E
Isolyte G
Isolyte M
Isolyte P

77. ALBUMIN
Pharmacological basis
Synthesized only in the liver and has a half-life of approximately 20 days
Principal transport protein in blood
Has significant antioxidant activity
Helps maintain the fluidity of blood by inhibiting platelet aggregation
Hyperoncotic (25%) albumin has been associated with an increased risk of renal
injury and death in patients with circulatory shock

78. What is Darrows solution?
Mixture of potassium chloride, sodium chloride, sodium lactate
Indication – correcting hypokalemia

79. Indications:
Emergency treatment of shock specially due to the loss of plasma.
Clinical situations of hypo-albuminemia
Following paracentesis.
Patients with liver cirrhosis.
After liver transplantation.

80. GELATIN POLYMERS( HAEMACCEL)
3 types of gelatin solutions-
• Succinylated or modified fluid gelatins (e.g.,Gelofusine, Plasmagel, Plasmion)
• Urea-crosslinked gelatins (e.g., Polygeline 3.5 %)
• Oxypolygelatins (e.g., Gelifundol)
Name one indication for Polygeline
Priming Of Heart Lung Machines

81. Pharmacological basis for hydroxyethyl starch
Anti-inflammatory properties: HES has been shown to preserve intestinal
microvascular perfusion in endotoxaemia due to their anti-inflammatory
properties

82. Disadvantages
Increase in Serum amylase concentration during and 3-5 days after
discontinuation
Affects coagulation by prolonging PTT, PT and bleeding time by lowering
fibrinogen, decrease platelet aggregation, VWF, factor VIII
HES products with medium to high MW are associated with oliguria, increased
creatinine, and acute kidney injury in critically ill patients with preexisting
renal impairment
Accumulates in reticuloendothelial system and causes pruritus

83. Precautions for dextaran
Dextrans coat the surface of red blood cells and can interfere with the ability to
crossmatch blood
Anticoagulant effect of heparin is enhanced
Dextrans produce a dose-related bleeding tendency-- impaired platelet
aggregation, decreased levels of Factor VIII and von Willebrand factor, and
enhanced fibrinolysis.

84. Case:
25 year old female, while riding a two wheeler was accidently hit by a car. She was
brought to our hospital. On examination she had degloving injury in the right lower
limb, no other injury. Her pulse is 120/min, BP – 90/60 mmHg. GCS – 15/15.
What is the type of shock expected in this patient?
Hypovolemic shock
What are the
types of shock?
Hpovolemic shock
Cardiogenic shock
Neurogenic shock
Obstructive shock

85. Case:
34-year-old male has presented to the
emergency department following a
large haematemesis. On examination, the
patient appears agitated. His pulse
is 120/min, blood pressure 122/84 mmHg
and respiratory rate 22/ min.
How would you classify the patient’s
current condition?
Class III hemorrhagic shock

86. Class I Class II Class III Class IV
Blood loss (ml) 750 750-1500 1500-2000 >2000
Blood loss (%blood
volume)
<15% 15-30% 30-40% >40%
HR <100 <100 >120 >140
Systolic BP No change No change ↓ Very low
Diastolic BP No change ↑ ↓ Un recordable
RR <20 >20 >30 >40
Urine output (ml/h) >30 20-30 10-20 <10
Extermities Normal pale Pale cold
Mental state Alert Anxious Aggressive/drowsy Confused/unconscious

87. What is the ideal replacement fluid for this patient?
Blood
Which blood group is known as universal donors ?
O blood group
What precautions will you take before giving dextran ?
Blood sample for crossmatching should to taken before the administration of dextran
because it interferes with the typing procedure
What is the IV fluid of choice in trauma patient? Crystalloids or colloids?
Crystalloids
What fluid is given in hypovolemic shock?
NS
When adequate urine out put is established – RL is given

88. Whole blood is store at what temperature ?

89. What are the complications of blood transfusion ?
Non hemolytic transfusion reaction - > 1C
TRALI – transfusion associated acute lung injury
ABO hemolytic reaction
Bacterial contamination – most common is gram negative
organism
Transmission of diseases – Hepatitis, AIDS
Allergic reaction and anaphylaxis
Transfusion associated circulatory overload

90. Define massive blood transfusion.
Replacement of blood volume equivalent with in 24 hours
(adult 70ml/kg, children – 80-90ml/kg)
>10 units of blood transfusion within 24 h
Transfusion of > 4 units of PRBC in 1 h when ongoing need is foreseeable
Replacement of 50% blood volume in 3 hours
Rate of blood loss > 150 ml/h

91. What are the complications of massive blood transfusion ?
Acidosis
Hyperkalemia
Citrate toxicity, hypocalcemia
Depletion of clotting factors, platelets
DIC
Hypothermia
Reduced 2,3 DPG
Micro aggregates

92. Why RL is preferred in hemorrhagic shock?
RL may be preferred in hemorrhagic shock
because it somewhat minimizes
acidosis and will not cause
hyperchloremia.
92
For patients with acute brain
injury
which fluid is preferred?
0.9% saline
RL
DNS
5%D

93. Why RL is preferred in hemorrhagic shock?
Because it somewhat minimizes acidosis and will not cause hyperchloremia
For patients with acute brain injury which fluid is preferred?
0.9% NS
RL
DNS
5% D
Answer – 0.9 % NS

94. How will you resuscitate this patient?
ATLS protocol – ABCDE
Airway
Breathing
Circulation, cervical spine protection
Disability limitation
Exposure
In emergency what blood group, blood is given to the patient?
O Rh-positive blood – male, old female (completed family)
O Rh – negative blood – young female

95. 95
When > 1 to 2 units are transfused (eg, in major trauma), blood is warmed to 37°C.
Patients receiving > 6 units may require replacement of clotting factors with
infusion of fresh frozen plasma or cryoprecipitate and platelet transfusion
What precaution will you take while transfusing blood?

96. Case:
Following a recent abdominal surgery, patient is
in the ICU with septic shock. Below what level of
hemoglobin would a blood transfusion be
indicated?
A. <12 g/dL
B. <10 g/dL
C. <8 g/dL
D. <7 g/dL
Answer: D <7g/dl 96

97. Case:
20 year old brought to the casualty with alleged H/O RTA. While riding a two
wheeler he skid and fell down. He had blunt injury of the chest.
O/E GCS 15/15, PR-120/min, BP-90/mmHg, RR – 30/min, SpO2 – 85%. JVP is
raised. Trachea is shifted to left side. He has having tenderness in the right side of
the chest. Crepitus felt. Tympanic on percussion. Air entry reduced on right side.
what is the most probable diagnosis for this patient?
Tension pneumothorax.
What type of shock patient can develop?
A. Hypovolemic shock
B. Vasodilatory shock
C. Cardiogenic shock
D. Obstructive shock

98. How will you treat this
condition?
ICD

99. What is the End Point of Monitoring in hypovolemic shock?
Urine output of > 0.5 to 1 mL/kg/h
Arterial blood lactate level
Base deficit
Sublingual tissue CO2 or near-infrared spectroscopy to measure tissue
oxygenation through the skin

100. The End