Initial resuscitation

Resuscitation refers to a series of therapeutic maneuvers intended to resto re a hemorrhaging patient's cardiovascular system as well as to obtain surg ical control of the source of bleeding and subsequently ensure adequate tis sue perfusion postoperatively. The term "initial resuscitation" refers to i nterventions performed either in the field, in the ambulance en route to th e hospital, or as part of the primary survey in the emergency center. Initi al resuscitation of trauma patients should achieve the following objectives : a) identify potentially life-threatening injuries; b) optimize physiologi c compensatory mechanisms; c) produce minimal immediate or long-term new in juries or complications; and d) assure maintenance of critical organ perfus ion. The traditional approach to traumatic shock with aggressive volume replacem ent has remained relatively unchanged for over 40 yrs, After achieving veno us access, intravenous fluids were administered to accomplish immediate res toration of intravascular volume, During the late 1980s, clinical and labor atory studies questioned the logic and clinical appropriateness of traditio nal resuscitative approaches to the critically injured patient. Challenging aggressive blood pressure elevation during ongoing hemorrhage has resulted in a major paradigm shift in the approach to initial resuscitation in the past decade. This article addresses current controversies of initial resusc itation including the type, volume, and timing of intravenous fluids; the r ole of intentional hypotensive resuscitation; organization issues within tr auma systems; and the resultant critical care implications of these changin g practices.