Essay on Use Of Fluid Resuscitation Following Trauma Example For Students

Essay on Use Of Fluid Resuscitation Following Trauma Crystalloid versus Colloids: Optimizing Fluid Resuscitation Following Trauma Blunt force trauma to the chest cavity can cause tremendous structural damage, resulting in compromised functional integrity to essential organs, such as the heart and the lungs. Because these primary organs facilitate perfusion to the rest of the body, damage can result in massive hypoperfusion leading to shock. Many researchers concur on the subject of fluid resuscitation to abate affects of cardiogenic shock and even death; however, the debate arises when considering types of fluid resuscitative therapy. Perpetual debates and literature has advocated for resuscitation with either crystalloid or colloid; supporting studies proclaim that one is superior to the other. To provide adequate treatment for patients experiencing cardiogenic shock, the practitioner must understand the pathophysiology of cardiac trauma and the anesthetic goals, and the role albumin plays in metabolic activity; furthermore, the practitioner should be aware of current literature contrasting crystalloid and col loid therapy in cardiogenic shock treatment. Pathophysiology of Cardiac Trauma and Anesthetic Goals Penetrating cardiac injuries often lead to immediate cardiovascular collapse, which patients rarely survive. Injuries associated with penetrating cardiac trauma include pericardial tamponade, cardiac perforation, rupture of a chamber, and fistula formation. Blunt cardiac trauma injuries include cardiac contusion; which are most common, pericardial ruptures, rupture of a chamber, valvular tears, coronary artery injuries, and ventricular aneurysms. The primary complication of pericardial tamponade is a decrease in cardiac output secondary to pericardial pressure causing severe diastolic dysfunction. Cardiac tamponade, which occurs when the pericardial sac surrounding the heart begins to fill with blood, can severe reduce forward flow. It presents as Beck’s triad: hypotension, distended neck veins, muffled heart sounds and pulsus paradoxus (Yao, 2012). The decrement of cardiac output by way of either these pathophysiologies can severely decrease perfusion to the renal, hepatic and neurological systems. Due to the decrease in oxygen deliver, metabolic acidosis can ultimately result. The anesthetic goal for treating acute cardiac trauma and cardiogenic shock is to maintain intrinsic sympathetic tone and preload (Yao, 2012). Therefore, use of vasopressors is essential. When considering maintenance of preload, researchers who advocate for resuscitation with colloids argue that albumin plays a major role in metabolic activity; therefore, it not only replaces volume, but it also induces essential metabolic activity that aids in healing and drug delivery. The role of Albumin in Metabolic Activity Serum albumin is a single-chain protein synthesized in and secreted from liver cells. Many researchers have studied the structure of serum albumin, its properties and functions to understand the protein’s interactions with a number of ligands (Alekseev Rebane, 2012). It has been discovered that albumin not only acts as a carrier protein for drugs, but also participates in catabolic activity such as hydrolysis. The albumin molecule consist of three domains: I, II and III; each of these domains have a subdomain A and subdomain B. Researchers has found these subdomains of the albumin molecule are essential for binding and transportation of antibiotics as well as other pharmaceuticals. The domain II and III of albumin contain two primary drug binding sites, known as Sudlow’s site I and site II (Alekseev Rebane, 2012). Albumin has been reported to exert irreversible effects on some beta lactam antibiotics. It was found that albumin of different purity obtained from a variety of sources, showed significant beta-lactamase activity. Purified albumin was shown to have a hydrolase activity, catalyzing the decomposition of the chromogenic cephalosporin. Furthermore, It was found that only cefuroxime, ceftazidime and cefoperazone interacted slightly with site I on serum albumin, while site II possessed the capacity to bind cephradine, cephalexin, ceftazidime, ceftriaxone, cefoperazone, cefaclor and cefsulodin (Alekseev Rebane, 2012). Therefore, albumin may facilitate healing by ensure the effective transport of antibiotics, which can decrease risk of infection and sepsis, which can lead to the triad of death. Along with the deliver of drugs, it is essential to maintain normal cellular activity, which is done through by series of serum enzymes such as esterase. Albumin plays a key role in hydrolytic activity. Stability of albumin was observed under conditions unfavorable for other blood serum esterases, in particular, in the absence of necessary co-factors, in the presence of specific inhibitors, or after preliminary heating. It was found that albumin was able to maintain its structure to a greater degree than other serum esterases. However, albumin hydrolysis activity turnover time is considerable slower than other esterase; thus, catalytic activity of serum albumin is classified as esterase-like or pseudo-esterase activity (Alekseev Rebane, 2012). Nonetheless, because of its sustainability and contribution of to catabolic activity, albumin replacement is essential. Cardiomyopathy : A Disease Of The Heat Muscle EssayReferences Alekseev, R., Rebane, A. (2012). Protein biochemistry, synthesis, structure and cellular functions: Serum albumin: Structure, Function and Health Impact. New York, NY: Nova. Retrieved from http://www.ebrary.com Khalid, R. (2012, July 16). Cardiogenic shock. Healthline. Retrieved from http://www.healthline.com/health/cardiogenic-shock#Overview1 Lira, A., Pinsky, M. (2014, Dec 4). Choices in fluid type and volume during resuscitation: impact on patient outcomes. Annals of Intensive Care , 4(38), 1-13. http://dx.doi.org/10.1186/s13613-014-0038-4 Yao, F. F. (2012). Yao Artusio’s Anesthesiology (7th ed.). Retrieved from http://www.r2library.com.une.idm.oclc.org/resource/title/1451102658