In a trauma patient, who is in shock was given 500ml of normal saline over 5-10 minutes. Blood pressure improved for 15 minutes and again it began to fall. Your inference is
Patient is having moderate ongoing fluid loss
Patient is having major ongoing fluid loss
Patient is not actively loosing fluid but require filling to a normal status
Patient is having fluid overload, which precipitated fuher shock
Dynamic fluid response: The shock status can be determined dynamically by the cardiovascular response to the rapid administration of a fluid bolus. In total, 250-500 mL of fluid is rapidly given (over 5-10 minutes) and the cardiovascular responses in terms of hea rate, blood pressure and central venous pressure are observed.Patients can be divided into 'responders', 'transient responders' and 'non-responders'.Responders have an improvement in their cardiovascular status that is sustained. These patients are not actively losing fluid but require filling to a normal volume status.Transient responders have an improvement, but this then reves to the previous state over the next 10-20 minutes. These patients have moderate ongoing fluid losses (either ove haemorrhage or fuher fluid shifts reducing intravascular volume). Non-responders are severely volume depleted and are likely to have major ongoing loss of intravascular volume, usually through persistent uncontrolled haemorrhage.Bailey and love 27e pg: 16
General surgery