scholarly journals Volume Resuscitation in the Acutely Hemorrhaging Patient: Historic Use to Current Applications

2021 ◽  
Vol 8 ◽  
Author(s):  
Kelly Hall ◽  
Kenneth Drobatz
Keyword(s):  
Blood Pressure ◽  
Blood Loss ◽  
Small Animal ◽  
Blood Component ◽  
Clinical Approach ◽  
Volume Resuscitation ◽  
Acute Hemorrhage ◽  
Blood Component Therapy ◽  
Canine Models ◽  
Crystalloid Administration

Acute hemorrhage in small animals results from traumatic and non-traumatic causes. This review seeks to describe current understanding of the resuscitation of the acutely hemorrhaging small animal (dog and cat) veterinary patient through evaluation of pre-clinical canine models of hemorrhage and resuscitation, clinical research in dogs and cats, and selected extrapolation from human medicine. The physiologic dose and response to whole blood loss in the canine patient is repeatable both in anesthetized and awake animals and is primarily characterized clinically by increased heart rate, decreased systolic blood pressure, and increased shock index and biochemically by increased lactate and lower base excess. Previously, initial resuscitation in these patients included immediate volume support with crystalloid and/or colloid, regardless of total volume, with a target to replace lost vascular volume and bring blood pressure back to normal. Newer research now supports prioritizing hemorrhage control in conjunction with judicious crystalloid administration followed by early consideration for administration of platelets, plasma and red blood during the resuscitation phase. This approach minimizes blood loss, ameliorates coagulopathy, restores oxygen delivery and correct changes in the glycocalyx. There are many hurdles in the application of this approach in clinical veterinary medicine including the speed with which the bleeding source is controlled and the rapid availability of blood component therapy. Recommendations regarding the clinical approach to volume resuscitation in the acutely hemorrhaging veterinary patient are made based on the canine pre-clinical, veterinary clinical and human literature reviewed.

scholarly journals Comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding: a computer simulation

2020 ◽  
Vol 15 (4) ◽  
pp. 459-465
Author(s):  
Young Sun Lee ◽  
Kyu Nam Kim ◽  
Min Kyu Lee ◽  
Jung Eun Sun ◽  
Hyun Jin Lim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Loss ◽  
Fresh Frozen Plasma ◽  
Massive Bleeding ◽  
Blood Component ◽  
Trauma Patients ◽  
Intraoperative Bleeding ◽  
Packed Red Blood Cells ◽  
Hemostatic Resuscitation ◽  
Traumatic Bleeding

Background: Appropriate blood component transfusion might differ between intraoperative massive bleeding and traumatic massive bleeding in the emergency department because trauma patients initially bleed undiluted blood and replacement typically lags behind blood loss. We compared these two blood loss scenarios, intraoperative and traumatic, using a computer simulation.Methods: We modified the multi-compartment dynamic model developed by Hirshberg and implemented it using STELLA 9.0. In this model, blood pressure changes as blood volume fluctuates as bleeding rate and transcapillary refill rate are controlled by blood pressure. Using this simulation, we compared the intraoperative bleeding scenario with the traumatic bleeding scenario. In both scenarios, patients started to bleed at a rate of 50 ml/min. In the intraoperative bleeding scenario, fluid was administered to maintain isovolemic status; however, in the traumatic bleeding scenario, no fluid was supplied for up to 30 min and no blood was supplied for up to 50 min. Each unit of packed red blood cells (PRBC) was given when the hematocrit decreased to 27%, fresh frozen plasma (FFP) was transfused when plasma was diluted to 30%, and platelet concentrate (PC) was transfused when platelet count became 50,000/ml.Results: In both scenarios, the appropriate ratio of PRBC:FFP was 1:0.47 before PC transfusion, and the ratio of PRBC:FFP:platelets was 1:0.35:0.39 after initiation of PC transfusion.Conclusion: The ratio of transfused blood component did not differ between the intraoperative bleeding and traumatic bleeding scenarios.

scholarly journals Improved Cardiovascular Tolerance to Hemorrhage after Oral Resveratrol Pretreatment in Dogs

2021 ◽  
Vol 8 (7) ◽  
pp. 129
Author(s):  
Jennifer Davis ◽  
Anthea L. Raisis ◽  
Claire R. Sharp ◽  
Rachel E. Cianciolo ◽  
Steven C. Wallis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Placebo Group ◽  
Blood Loss ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Kidney Injury ◽  
Bleeding Risk ◽  
Canine Model ◽  
Coagulation Parameters ◽  
Renal Tubular

Resveratrol has been shown to preserve organ function and improve survival in hemorrhagic shock rat models. This study investigated whether seven days of oral resveratrol could improve hemodynamic response to hemorrhage and confer benefits on risk of acute kidney injury (AKI) without inducing coagulopathy in a canine model. Twelve greyhound dogs were randomly allocated to receive oral resveratrol (1000 mg/day) or placebo for seven days prior to inducing hemorrhage until a targeted mean blood pressure of ≤40 mmHg was achieved. AKI biomarkers and coagulation parameters were measured before, immediately following, and two hours after hemorrhage. Dogs were euthanized, and renal tissues were examined at the end of the experiment. All investigators were blinded to the treatment allocation. A linear mixed model was used to assess effect of resveratrol on AKI biomarkers and coagulation parameters while adjusting for volume of blood loss. A significant larger volume of blood loss was required to achieve the hypotension target in the resveratrol group compared to placebo group (median 64 vs. 55 mL/kg respectively, p = 0.041). Although histological evidence of AKI was evident in all dogs, the renal tubular injury scores were not significantly different between the two groups, neither were the AKI biomarkers. Baseline (pre-hemorrhage) maximum clot firmness on the Rotational Thromboelastometry (ROTEM®) was stronger in the resveratrol group than the placebo group (median 54 vs. 43 mm respectively, p = 0.009). In summary, seven days of oral resveratrol did not appear to induce increased bleeding risk and could improve greyhound dogs’ blood pressure tolerance to severe hemorrhage. Renal protective effect of resveratrol was, however, not observed.

Three new antihypertensive drugs: esbatal, envacar and vatensol

1964 ◽  
Vol 2 (11) ◽  
pp. 41-42
Keyword(s):  
Blood Pressure ◽  
Blood Loss ◽  
Thiazide Diuretic ◽  
Antihypertensive Drugs ◽  
Standing Position ◽  
Adrenergic Blockade ◽  
Concurrent Administration ◽  
Hot Environment ◽  
Nasal Stuffiness

These chemically related drugs lower the blood pressure by blocking adrenergic neurones, and their effects resemble those of guanethidine and bretylium. Concurrent administration of a thiazide diuretic potentiates each of these drugs, thus allowing the dose to be reduced. As might be expected the greatest reduction in blood pressure normally occurs in the standing position, but symptoms of hypotension, such as faintness, giddiness and weakness occur if the dose is excessive or under conditions which potentiate the effect of adrenergic blockade, for example, on first rising from bed, in a hot environment, during and after exercise, and after blood loss. Other symptoms caused by adrenergic blockade, such as nasal stuffiness and failure of ejaculation are common. Impotence has been reported.

The Study of Dynamic Response to Acute Hemorrhage by Pulse Spectrum Analysis

2006 ◽  
Vol 34 (03) ◽  
pp. 449-460 ◽  
Author(s):  
Yu Hsin Chang ◽  
Chia I Tsai ◽  
Jaung Geng Lin ◽  
Yue Der Lin ◽  
Tsai Chung Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Steady State ◽  
Arterial Blood Pressure ◽  
Mean Arterial Blood Pressure ◽  
Spectrum Analysis ◽  
Pulse Spectrum ◽  
Acute Hemorrhage ◽  
Arterial Blood ◽  
Percentage Difference ◽  
Before And After

Traditional Chinese Medicine (TCM) holds that Blood and Qi are fundamental substances in the human body for sustaining normal vital activity. The theory of Qi, Blood and Zang-Fu contribute the most important theoretical basis of human physiology in TCM. An animal model using conscious rats was employed in this study to further comprehend how organisms survive during acute hemorrhage by maintaining the functionalities of Qi and Blood through dynamically regulating visceral physiological conditions. Pulse waves of arterial blood pressure before and after the hemorrhage were taken in parallel to pulse spectrum analysis. Percentage differences of mean arterial blood pressure and harmonics were recorded in subsequent 5-minute intervals following the hemorrhage. Data were analyzed using a one-way analysis of variance (ANOVA) with Duncan's test for pairwise comparisons. Results showed that, within 30 minutes following the onset of acute hemorrhage,the reduction of mean arterial blood pressure was improved from 62% to 20%. Throughout the process, changes to the pulse spectrum appeared to result in a new balance over time. The percentage differences of the second and third harmonics, which were related to kidney and spleen, both increased significantly than baseline and towards another steady state. Apart from the steady state resulting from the previous stage, the percentage difference of the 4th harmonic decreased significantly to another steady state. The observed change could be attributed to the induction of functional Qi, and is a result of Qi-Blood balancing activity that organisms hold to survive against acute bleeding.

Blood Component Therapy and Massive Transfusion

2018 ◽  
pp. 547-568
Author(s):  
Shiu-Ki Rocky Hui ◽  
Kjersti Marie Aagaard ◽  
Jun Teruya
Keyword(s):  
Massive Transfusion ◽  
Blood Component ◽  
Blood Component Therapy

scholarly journals CHANGE OF FUNCTIONAL AND LABORATORY PARAMETERS AFTER COMPENSATION OF ACUTE BLOOD LOSS WITH COOLED HYPERTONIC SOLUTION IN EXPERIMENT

2018 ◽  
pp. 83-94
Author(s):  
A. V. Krupin ◽  
I. A. Shperling ◽  
P. A. Romanov ◽  
M. I. Shperling
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Loss ◽  
Blood Plasma ◽  
Hypertonic Solution ◽  
Acute Blood Loss ◽  
External Temperature ◽  
Heat Chamber ◽  
Quantitative Indicators ◽  
Experimental Group

Relevance.High efficiency of hypertonic (hyperosmolar) solutions in acute blood loss is known. However, data on changes in the body, developing as a result of infusion of such drugs (including cooled) in the providing of care after acute blood loss is limited or absent. This fact complicates the development of tactics in their use, especially in emergency situations at low temperatures.Intention.To reveal features of functional and laboratory indicators In experiments on animals as a result of infusion of warm (+22 °С) or the cooled (–3 °С) hypertonic solution based on hydroxyethyl starch and sodium chloride (HyperHAES, further – HHES) at the acute blood loss of 50 % of blood volume (BV).Methodology.Animals (20 male sheep) with modeled blood loss were distributed into 2 experimental and 2 control groups of 5 animals each. Sheep in the 1st experimental group were placed in the heat chamber with temperature –7 °С for 15 min. Then they underwent the intravenous infusion of a cooled HHES at a dose of 4 ml/kg of weight through the jugular vein with a disposable syringe (volume 20 ml) evenly with a speed of 60 ml per minute. After that they were left in the heat chamber until the time of 1 hour in total. Individuals in the 2nd experimental group were injected with an equivalent volume of warm solution during the corresponding periods of the experiment at an external temperature of +22 °C. 1 hour after beginning of the infusion all animals were intravenously injected with colloidal solution based on hydroxyethyl starch (“Voluven”) at an external temperature of +22 °C. During 1 day the dynamics of rectal temperature, arterial pressure, heart rate and respiratory movements, osmolarity of blood plasma and content of osmotically active components, quantitative indicators of red blood were evaluated.Results.Animals at a temperature of +22 °C or at a temperature of –7 °C died in (82 ± 3) min and (70 ± 5) min (p < 0.05) respectively after the start of exfusion. Intravenous fluids (warm or cooled HHES) ensured the survival in 100 % of cases. As a result of blood loss, subsequent infusion of cooled HHES and following presence in the heat chamber, rectal temperature in sheep decreased by 4.9 °C (14.2%, p < 0.05) relative to the initial values. Two and 4 min after infusion of cooled or warm HHES systolic blood pressure increased by 24.9 % (p < 0.05) and 14.9 % (p < 0.05), respectively, and were restored to the normal level during the following 40 min. Infusion of “Voluven” contributed to the stabilization of blood pressure within 1 day after infusion of HHES. Blood loss led to increased heart rate by 2.1 times (p < 0.05), infusion of HHES slightly reduced the severity of tachycardia. Within 10 minutes after the introduction of cooled HHES, dynamics of heart rate was less stable. Infusion of warm or cooled HHES increased osmolarity of blood plasma by 9.5–9.9 % (p < 0.05), which was associated with an increase of sodium and glucose concentrations in blood. Infusion of “Voluven” reduced osmolarity of blood plasma, which became similar to initial values at the end of Day 1 after infusion of HHES. Blood loss, infusion of HHES and “Voluven” decreased quantitative indicators of red blood via removal of red blood cells from the bloodstream, as well as compensatory and post-transfusion hemodilution.Conclusion.The infusion of warm or cold hypertonic saline (HyperHAES) ensures the survival of experimental animals in post-hemorrhagic period. The positive effect of the drug is associated with compensatory haemodilution (including increased osmolarity of blood plasma), as well as with better functioning of the cardiovascular system. Specific cooled HHES effects include an earlier and pronounced rise in blood pressure. Considering changes in functional and laboratory parameters after infusion of warm or cooled HHES, a reliable system should be developed to remove casualties from emergency areas and to take earlier and complete diagnostic and treatment measures.

scholarly journals The first report of direct skeletal attachment method applying for tibia prosthetic leg in a chicken by cortical screw

2019 ◽  
Vol 2 (3) ◽  
pp. 3-5
Author(s):  
Piyabongkarn Damrongdej
Keyword(s):  
Stainless Steel ◽  
Blood Loss ◽  
Endotracheal Tube ◽  
Surgical Procedure ◽  
Small Animal ◽  
Long Bone ◽  
Long Bones ◽  
First Report ◽  
Cortical Screw ◽  
Intramedullary Screw

This is the first report of successful method for direct skeletal attachment for invent tibia prosthetic leg in a chicken amputee by using 3.0 mm stainless steel cortical screw as an intramedullary bone stem for right tibia endoprosthesis leg part and using acrylic with some part of endotracheal tube as an exoprosthesis leg part. This surgery was performed in a chicken amputee without bone cement using. A chicken could stand and sometime walk after 15 days of surgery. No complication problem with a screw’s stump. This intramedullary bone stem technique by a screw can adapt using in other parts of long bone animal amputee. This technique can apply for invent endoprosthesis limb in other small animal amputees and can use intramedullary screw technique with other long bones such as femur, humerus, radius, and ulna because this technique uses only one stainless 316L screw so the surgery cost is not too much. The surgical procedure is not complicated and blood loss during surgery is not much so the risk for this technique is low.

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