volume resuscitation in patients with hemorrhagic shock at Muhimbili orthopedic institute Small

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University of Dar es Salaam
A cross sectional descriptive study was conducted at Muhimbili Orthopaedic Institute (MOI) casualty describing the immediate clinical outcome in patients with hemorrhagic shock before and after resuscitation with locally made 250mls of 7.5% Hypertonic saline solution. Between July and December 2005, 45 adult trauma patients with hemorrhagic shock were enrolled into the study. Vital signs and venous blood for serum sodium, chloride, haemoglobin and haematocrit were taken before and after an infusion of 250mls of 7.5% HSS. The infusion was administered through cannula gauge 16. Data were analysed using SPSS version 12. Eighty nine percent of patients recovered from shock immediately after an infusion of 250mls of 7.5% HSS. Systolic blood pressure, Diastolic blood pressure and peripheral Oxygen saturation (Sa02) increased with a mean increase of 38.30±12.75mmHg, 24.04±11.00mmHg and 7.64%±6.95 respectively (p < 0.001). Pulse and heart rate dropped significantly to normal levels. Serum sodium and chloride levels increased moderately from baseline. (Mean rise 10.96±3.09mmol/L and 10.91 ±4.6lmmol/L respectively) Hematocrit and Haemoglobin dropped by 4.42% and 1.5g/dL respectively (p<0.001). Five patients (14.3%) had pain at infusion site, there were no other reported unwanted effects. Eighty percent of patients survived beyond 24 hours post resuscitation. There was significant association between age, type of injury and class of shock sustained with survival beyond 24 hours. However, with logistic regression analysis these parameters show no significant association. Conclusion • This is the first study on small volume resuscitation in East Africa. It has demonstrated beneficial clinical outcome in initial treatment of hemorrhagic shock at the casualty settings. Side effects are rare and generally without any upshot. It is safe and effective in initial treatment of acute haemorrhage. Recommendations • An extensive clinical trial is needed to compare its beneficial effects with the currently used isotonic fluids and identify its efficacy in improving survival.
Available in print form, East Africana Collection, Dr. Wilbert Chagula Library, Class mark (THS EAF RH316.H46S53)
Hemorrhagic shock, Volume resuscitation
Sakwari, V (2006) volume resuscitation in patients with hemorrhagic shock at Muhimbili orthopedic institute Small , Master dissertation, University of Dar es Salaam. Dar es Salaam.