From the Research
For a patient with a blood pressure of 110/70, the best bore cannula would be 18 gauge (2nd degree). This size provides adequate flow for routine IV therapy while minimizing trauma to the vein, as the patient's blood pressure is within normal range and doesn't indicate an emergency situation requiring larger bore access. For a shocked patient who is anxious, restless, confused, with BP 80/40, the most appropriate fluid would be non-cross matched O negative blood (D). This patient is showing signs of hypovolemic shock requiring immediate volume replacement. O negative blood is the universal donor and can be given without cross-matching in life-threatening emergencies when there isn't time to wait for type-specific blood 1. A post-RTA (road traffic accident) patient with BP 80/60, HR 110, RR 20 is in the second stage of shock (A). This classification is based on the moderate hypotension, tachycardia, and normal respiratory rate, which are consistent with compensatory mechanisms attempting to maintain perfusion. Second stage shock typically involves 15-30% blood volume loss, where the body is still able to partially compensate but shows clear signs of cardiovascular compromise. Some key points to consider in the management of shock include:
- The use of vasopressors and inotropes to increase systemic vascular resistance and cardiac contractility, respectively 2, 3
- The selection of appropriate fluids for resuscitation, such as lactated Ringer's solution or normal saline, depending on the patient's specific needs and the underlying cause of shock 1, 4
- The importance of monitoring the patient's hemodynamic status and adjusting treatment accordingly to optimize outcomes 2, 3 It's also worth noting that the choice of fluid for resuscitation can have significant effects on the patient's outcome, with some studies suggesting that lactated Ringer's solution may be associated with improved survival and reduced morbidity compared to normal saline 1, 4. However, the optimal choice of fluid will depend on the individual patient's needs and the specific context of their care.