![]() But one must exercise caution, because an aggressive large volume fluid resuscitation may lead to hypothermia, acidosis, and coagulopathy. The overall goal is to replace the fluid lost from the interstitial compartment to the intravascular spaces. Activation of the renin-angiotensin-aldosterone system occurs next, activated by the reduction in renal perfusion and causing sodium and water retention by the kidneys. The resultant effect is the sequestration of about 1 liter of fluid into intravascular spaces. ![]() Trans-capillary refill occurs first and involves the shift of fluid from the interstitial space into the intravascular space secondary to increased capillary permeability and decreased plasma colloid osmotic pressure. Trauma and acute blood loss trigger compensatory mechanisms aimed at restoring volume deficits to maintain adequate perfusion of vital organs. Blood losses of greater than 20% will require fluid resuscitation to support the continued delivery of oxygen to vital organs. The compensatory mechanisms click in when there is acute blood loss of more than 5% to 10%. ![]() Loss of blood triggers a compensatory hemodynamic response to restore volume. Among them, hemorrhagic shock is the primary cause of death for 30% to 40% in the first 24 hours following injury. Trauma is the number one cause of death in the United States for individuals between 1 and 44 years of age. ![]()
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