Question

You are preparing to perform fluid replacement on an adult trauma patient who lost a significant amount of his circulating blood volume when you note the presence of a drastic systolic blood pressure decline from 100 mmHg to 86 mmHg systolic after the patient's bleeding is controlled. The patient has no obvious new bleeding, but his abdomen is distended and is painful on palpation. There are no obvious masses, bruises, or deformity, and he has active bowel sounds over the epigastric region.

Which of the following intravenous fluids would be most appropriate in this situation if the medical command physician recommends a fluid challenge?

A. 0.9% normal saline

B. 0.45% sodium chloride

C. 0.45% normal saline with 5% dextrose

D. Lactated Ringer's solution

Answer 1

Lactated Ringer's solution is the most appropriate intravenous fluid for fluid replacement in an adult trauma patient with a significant blood volume loss and signs of intra-abdominal bleeding.

Step-by-step explanation:

In this situation, the most appropriate intravenous fluid would be Lactated Ringer's solution. Lactated Ringer's solution is an isotonic solution that contains electrolytes (sodium, potassium, calcium, and chloride) which closely mimic the electrolyte composition of plasma. It also contains lactate, which can be metabolized into bicarbonate, helping to buffer the pH of the blood.

Given the patient's systolic blood pressure decline, distended abdomen, and palpation pain, it suggests the presence of hypovolemia and potential intra-abdominal bleeding. Lactated Ringer's solution is the preferred choice for fluid replacement in trauma patients with hemorrhagic shock as it provides both volume expansion and helps to correct metabolic acidosis.

In contrast, the other options (0.9% normal saline, 0.45% sodium chloride, and 0.45% normal saline with 5% dextrose) may not be as ideal for this specific situation.