Resuscitation



Unless bleeding is mild or chronic, patients are placed in an intensive care unit. Although initial management is usually conducted by internists, surgical consultation at this stage is mandatory, as surgical intervention may be urgently required, and the decision to intervene surgically is greatly facilitated by the patient’s being jointly followed by both medical and surgical teams. Resuscitation is directed toward maintaining the intravascular volume and providing adequate tissue oxygena­tion. Nasal oxygen may be used, particularly in the elderly or in patients with cardiac or pul­monary disease. Vital signs, urine output, and, in some cases, central venous or pulmonary wedge pressure are monitored.

Actively bleeding patients are given whole blood to replace volume losses. However, if the patient is hemodynamically stable as a result of plasma volume restoration from the extravascular space and intravenous administration of crystal­loids, packed cells may be given.

Blood is given according to the volume lost, the presence of continued bleeding, pre-existing ane­mia, and the ability of the patient to withstand blood loss. Thus, severe active bleeding may re­quire whole blood administration under pressure via several intravenous lines. On the other hand, an otherwise healthy young person who is hemodynamically stable and who has stopped bleeding from a duodenal ulcer may tolerate a he­matocrit of 25 per cent quite well and may be treated with oral iron. In general, evidence of hy­potension, diminished tissue perfusion, or con­tinued bleeding is an indication for transfusion.