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In this 293rd episode I interview Dr. Keith Baker in another master clinician episode. Dr. Baker is a professor at Harvard Medical School, the Vice Chair for Education at MGH and was formerly the residency program director there for 15 years.
CME: Link
Random Recs:
Can you please share the original text talking about replacing balance crystalloid to blood in a 5:1 ratio loss to prevent hypovolemia. I looked for it and was unsuccessful but I did find many that said three to one was the correct ratio.
Dr. Baker is happy to share these references but also says he would appreciate if you would share the references you’ve found that say it is 3:1 so he can take a look at them. Thanks!
J. Dillon et al. The treatment of hemorrhagic shock. Surg Gynecol Obstet. 1966 May;122(5):967-7
One of the earliest studies showing crystalloid distributes 5:1 (actually 5.7: 1)
Cervera and Moss. Progressive hypovolemia leading to shock after continuous hemorrhage and 3:1 crystalloid replacement. The American Journal of Surgery. Volume 129, Issue 6, June 1975, Pages 670-674
An early study showing that 3:1 replacement for big bleeds does not work and leads to shock.
Greenfield et al. Effect of crystalloid infusion on hematocrit and intravascular volume in healthy, nonbleeding subjects. Annals of Emergency Medicine, Volume 18, Issue 1, 51 – 55 1989
Humans redistribute LR 5:1 with a time constant of about 20 minutes
Lobo et al. Effect of volume loading with 1 liter intravenous infusions of 0.9% saline, 4% succinylated gelatine (Gelofusine) and 6% hydroxyethyl starch (Voluven) on blood volume and endocrine responses: a randomized, three-way crossover study in healthy volunteers. Crit Care Med. 2010 Feb;38(2):464-70
Humans redistribute NS 5:1