Adequate response to fluids in a trauma pt

[NipponMD]

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If a trauma pt w/ presumed abdominal injury comes in with systolic BPs in the 70/20s and HR 110s, gets 2L LR and is in the 80s/30s, still in the 110s, this is inadequate response and laparotomy is indicated to find the source of bleeding... But what would be an adequate response so that you'd do FAST instead?

 

[chocomorsel]

If a trauma pt w/ presumed abdominal injury comes in with systolic BPs in the 70/20s and HR 110s, gets 2L LR and is in the 80s/30s, still in the 110s, this is inadequate response and laparotomy is indicated to find the source of bleeding... But what would be an adequate response so that you'd do FAST instead?

Good question, I always choose DPL if the patient is unstable hemodynamically, has a tender abd. with decreased bowel sounds. And so far I've been pretty much right. But if DPL is not available, I go for the FAST. And I just came across another UW world question that explained that both of these approaches are correct these patients. So hopefully you won't come across a question that gives you both answer choices. And I don't know what the rule of thumb is for the amt of fluid given vs. increase in B/P. But I would say a systolic rise of 30 or more would be a good sign after 2 liters. But just my opinion.
Funny thing, I did trauma as one of my surgery rotation and never got to see any of those two. The few that we had, I believe went straight to the OR for exploration. Anyway, hope this helps.

 

[BillyWitchDoctr]

I agree. Per USMLEWorld you should also perform laparotomy any time there is the possibility of abdominal involvement (I think below the 4th intercostal) from a GSW.

 

[abbaroodle]

I took it yesterday and while I was wondering the same thing (what's adequate), it was quite obvious. Either the BP didnt move or it went up a lot. Which was also what I found with UW. (No fuzzy middle of maybe adquate.)