The nurse in a rural nursing outpost has just been notified that she will be receiving a patient in hypovolemic shock due to a massive postpartum hemorrhage after her home birth
You know that the best choice for fluid replacement for this patient is what?
A) 5% albumin because it is inexpensive and is always readily available
B) Dextran because it increases intravascular volume and counteracts coagulopathy
C) Whatever fluid is most readily available in the clinic, due to the nature of the emergency
D) Lactated Ringer's solution because it increases volume, buffers acidosis, and is the best choice for patients with liver failure
Ans: C
Feedback:
The best fluid to treat shock remains controversial. In emergencies, the "best" fluid is often the fluid that is readily available. Fluid resuscitation should be initiated early in shock to maximize intravascular volume. Both crystalloids and colloids can be administered to restore intravascular volume. There is no consensus regarding whether crystalloids or colloids, such as dextran and albumin, should be used; however, with crystalloids, more fluid is necessary to restore intravascular volume. Albumin is very expensive and is a blood product so it is not always readily available for use. Dextran does increase intravascular volume, but it increases the risk for coagulopathy. Lactated Ringer's is a good solution choice because it increases volume and buffers acidosis, but it should not be used in patients with liver failure because the liver is unable to covert lactate to bicarbonate.
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