Association of Surgeons of East Africa and College of Surgeons of East Central and Southern Africa
Abstract
Background: Haemorrhagic shock is a major cause of morbidity and
mortality worldwide. Trauma and its complications account for one in
ten deaths worldwide and are the leading cause of death in those below
45 years of age in developed countries. Survival of the shocked patient
is influenced by the speed and efficiency with which resuscitation is
carried out. Rapid infusion of a small volume of 7.5% hypertonic saline
(HSS) has been shown to result in immediate restoration of circulating
volume and tissue perfusion but results of investigation of its use
remain inconclusive. The objective of this study was to determine the
clinical outcomes of infusing locally made 7.5% HSS in patients with
haemorrhagic shock. Methods: During a six-month period, all adult
trauma patients coming to the casualty with haemorrhagic shock were
enrolled into the study. A detailed clinical assessment was performed,
and respiratory and cardiovascular vital signs were recorded. Five
millilitres of venous blood was drawn for determination of Haematocrit,
haemoglobin, serum electrolytes and creatinine. A rapid infusion of
250mls of HSS was given intravenously followed three to five minutes
later by recording the vital signs again and drawing another 5 mls of
blood for a repeat of the laboratory tests. Recovery from shock was
followed by standard fluid infusion. Additional or alternative
resuscitation and other therapeutic measures were taken as indicated.
Recording of the vital signs was continued at four hourly intervals for
24 hours. The data were entered into a computer data base and analysed.
Results: Forty five patients were enrolled and resuscitated with 250
mls 7.5% HSS. Among the studied patients, 88.9% recovered from shock
immediately after being infused with 7.5% HSS. Of patients with a
single injury, 96.6% recovered from shock whereas only 75% of those
with multiple injuries recovered. Eighty percent of patients survived
beyond 24 hours post resuscitation. While 93.1% of patients with a
single injury survived beyond 24 hours, only 56.3% of those who
sustained multiple injuries did so. Conclusion: Rapid resuscitation
with HSS has demonstrated clinical benefits in initial treatment of
traumatic hemorrhagic shock in patients admitted to the emergency room.
Further investigation of the effects of HSS resuscitation is warranted
