Abdominal Vascular Injuries Medication
- Author: Timothy H Pohlman, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, MA more...
The most important aspects of medical therapy for patients with vascular injuries are adequate oxygen delivery and crystalloid fluid administration. Although colloid solution is mentioned, the mortality benefit of colloid over crystalloid has never been proven. Blood transfusion may also be beneficial for patients with low hemoglobin concentrations.
Isotonic sodium chloride (normal saline [NS]) and lactated Ringer (LR) are isotonic crystalloids, the standard intravenous (IV) fluids used for initial volume resuscitation. They expand the intravascular and interstitial fluid spaces. Typically, about 30% of administered isotonic fluid stays intravascular; therefore, large quantities may be required to maintain adequate circulating volume.
Both fluids are isotonic and have equivalent volume-restorative properties. While some differences exist between metabolic changes observed with the administration of large quantities of either fluid, for practical purposes and in most situations, the differences are clinically irrelevant. No demonstrable difference in hemodynamic effect, morbidity, or mortality exists between resuscitation with NS or LR.
Normal saline (NS, 0.9% NaCl)
NS restores interstitial and intravascular volume. It is used in initial volume resuscitation.
LR restores interstitial and intravascular volume. It is used in initial volume resuscitation.
Colloids are used to provide oncotic expansion of plasma volume. They expand plasma volume to a greater degree than isotonic crystalloids and reduce the tendency of pulmonary and cerebral edema. About 50% of the administered colloid stays intravascular.
Albumin is used for certain types of shock or impending shock. It is useful for plasma volume expansion and maintenance of cardiac output. A solution of NS and 5% albumin is available for volume resuscitation. Five percent solutions are indicated to expand plasma volume, whereas 25% solutions are indicated to raise oncotic pressure.
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|Artery Injured||Vein Injured|
Primary named vessels of superior mesenteric
Vena cava (infrarenal)
|IV||Superior mesenteric (trunk)|
|Vena cava (infrahepatic)|
|V||Aorta (suprarenal)||Vena cava (suprahepatic)|
Vena cava (retrohepatic)
|* Grade I injury includes the following: No named superior mesenteric artery or superior mesenteric vein branches; nonnamed inferior mesenteric artery or inferior mesenteric vein branches; phrenic artery/vein; lumbar artery/vein; gonadal artery/vein; ovarian artery/vein; other nonnamed small arterial or venous structures requiring ligation.|