Pop Quiz Hotshot

I’m reading my way through “The Little ICU Book” and it’s surprisingly good reading. Straightforward and all high yield stuff.  (I’m actually going to take it on vacation with me next week.) While reading,  I’ve come across a few things that I had never heard of in medical school, or were not made entirely clear, or I just wasn’t paying attention when it was it taught. I’ve always learned best by quizzing myself, so in that vein, this will be the first of hopefully many pop quizzes about of EM and ICU care. I’m sure for the next year or so these will all be pretty basic, so no worries. Answers will be in the comments.

Q: What fluid type (colloid, crystalloid, whole blood, packed RBCs) is the most effective for resuscitation in the setting of acute blood loss? Why?

About ER Jedi

I’m a resident doctor in Emergency Medicine and I’ve learned during the past few years that 1) I’ve had some pretty amazing experiences 2) I have a very bad short-term memory. So this blog is just a place for me to write about some of these experiences, from the ER, medical school, the wards and life in general. At least that way I’ll have some idea as to where I’ve been all this time. A scrap-book of sorts, a place to vent, organize some clinical tools and post a few good songs I’ve heard along the way.

Posted on April 28, 2011, in Pop Quiz. Bookmark the permalink. 3 Comments.

  1. A: Colloid fluids. The ultimate goal of volume resuscitation for acute blood loss is to maintain oxygen uptake into tissues and sustain aerobic metabolism. The consequences of low cardiac output are far more threatening than the consequences of anemia, so the first priority in the bleeding patient is to support cardiac output. Colloid fluids contain large molecules with limited movement out of the bloodstream and they are designed to expand the plasma volume. Compared to crystalloid fluids, 75% of colloid fluids will remain intravascularly while only 25% of crystalloid fluids remain. On a volume to volume basis, colloid fluids are about twice as effective as whole blood, six times more effective than packed cells and eight times more effective than crystalloid fluid. The limited ability of blood (particularly packed RBCs) to augment cardiac output is due to the viscosity effects of erythrocytes. Some studies have show that packed RBCs can actually decrease cardiac output.

  2. Haha, if I ever get more people than you wanting the answer the questions, then yes, I suppose I can wait. 🙂

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