What we do know, according to Dr. Dickinson, is that shock is a complicated process. While we think of it as decreased perfusion at the cellular level, it actually involves chemical receptors, chemoreceptors and baroreceptors. Shock leads to significant damage to the cardiovascular system, as well as the renal system, and the gastrointestinal system. Recent shock resuscitation research has demonstrated that when resuscitation is too aggressive the resulting reperfusion can trigger major cellular dysfunction and permanent injury or death at the cellular level. This reperfusion phenomena is not unlike what is occurs in the myocardium during fibrinolytic therapy.
Today crowd down.
He started off with the crystalloids, the most common fluid for resuscitation. This includes normal saline and lactated ringers. These are not without potential complications such as ARDS or hemodilution. However, LR can cause confusion, increased neutrophil activation, and possibly cardiac complications. As a result of the hyperosmotic state, smaller volumes are needed as fluid is returned to the vascular system from interstitial spaces in an effort to normalize the saline concentration.