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Old 04-04-2012
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Emergency Stop bleeding first or fluid ressuscitation first?

Hi all:

In Kaplan surgery it says that if we know where is bleeding then we should stop the bleeding first and if we dont know the culprit for bleeding then we give fluid first.

So if today we have gun shot in the neck we should stop bleeding first?
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Old 04-05-2012
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as a rule, you first stop bleedin n thn give fluids bcoz if u dont do so you ll end up running isotonic fluids in vessels with no blood products in them. so stop bleeding n thn give fluids. regarding neck gun shot wound, neck has limitated space, so the bleeding forms hematoma n hematoma itself stops bleeding. in case if it doesnt happen, you stop the bleeding or try to stop the bleeding wid pressure, at the same time you give fluids thru 2 16 bore IV cannula and take the patient to OR. dont forget the simple n basic rule, every gun shot wound in neck above cricoid cartilage n below the angle of mandible gets explored in operating room even if patient is stable i.e. pt's b.p is 120/80, you still operate. i hope you got the answer
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Old 04-05-2012
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the thing is... you start iv fluids first.... it doesnt matter how much the person has been bleeding....
the idea behind it is that you waste some time before you work up to find the bleed (esp. if it is a consealed one)... the patient's circulation is compromised and can lead to end organ damage....
plus you can assess the type of bleeding if the patient responds well or not to the fluids... also, in trauma settings... (mva) the emergency personels cannot afford to waste time in finding the bleed origin, rather start fluids and so called 'scoop n run'
the type of fluids required can be selected on other factors and labs.... (palor, cold clammy, dry skin, mucosa etc..)

large iv bores plus fluids is first... finding the cause is after that...

now in neck trauma.... there are 3 zones....
middle zone is the most vulnerable to vascular injury.... in this case, u will go for surgical exploration and stop bleed if patient is unstable(hypotensive, gurgling voice, hemetemesis, heavy or continual bleeding.) if the patient is stable, go for angio, endo, etc....
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Old 04-05-2012
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if there's single gun shot wound or an identifiable source of bleeding that's readily seen,u can first try controlling the bleeding and give fluids afterwards..but if there are multiple gun shot wounds u should not waste time in trying to stop the bleeding give fluids and proceed to surgery which will be needed to correct them !!
source MTB3 page 286 (abdominal trauma)
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Old 04-05-2012
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nikhilesh, everything you said, i agree with it BUT

"now in neck trauma.... there are 3 zones....
middle zone is the most vulnerable to vascular injury.... in this case, u will go for surgical exploration and stop bleed if patient is unstable(hypotensive, gurgling voice, hemetemesis, heavy or continual bleeding.) if the patient is stable, go for angio, endo, etc...."

but the above statement you wrote is not true. gun shot wound in middle zone of neck is like gun shot wound of abdomen. in both you have to do surgical exploration whether the pt is stable or not, surgical exploration is must do for these 2. regarding other zones of neck, for zone 1 or lower zone, if pt is stable and asymptomatic, do angio, esophagoscopy, esophagogram, bronchoscopy. for zone 3 or upper zone, if pt is stable you do angiogram
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