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Zdravljenje s tekočinami je pomemben vidik nadzora poškodovancev s hemoragičnim šokom, zato je namen diplomskega dela predstaviti fiziologijo in patologijo hemoragičnega šoka, opisati vrste tekočin za nadomeščanje izgube krvi, ter vpliv tekočin na vitalne funkcije poškodovancev. Katero tekočino uporabiti je bila tema že večletnih razprav, vendar je še vedno premalo dokazov, ki bi dale prednost eni tekočini pred drugo. Vsaka vrsta tekočine ima svoje prednosti kot tudi slabosti, s preobremenitvijo s tekočinami lahko poškodovancu povzročimo več škode kot koristi. Zato smo tudi podrobneje opisali tekočine, kot so koloidi (albumin, želatini, dekstran in hidroksietilni škrob) v nasprotju s kristaloidi (natrijev klorid in Ringerjev laktat), njihove lastnosti in strukturo. Izvedena je bila kvantitativna raziskava s pomočjo vprašalnika in protokolov. Rešenih je bilo 30 anket na eni izmed Prehospitalnih enot Reševalne postaje po Sloveniji, z namenom ugotoviti splošno znanje zdravstvenega osebja (diplomirane medicinske sestre/zdravstveniki, tehniki zdravstvene nege) o hemoragičnemu šoku, ter izvedeti kako pogosto se srečajo s poškodovancem s sliko hemoragičnega šoka na terenu. Z vpogledom njihovih protokolov smo poskušali zbrati podatke o učinkih različnih vrst tekočin na spremembe v vitalnih funkcijah poškodovancev. Fluid resuscitation is essential aspect of the management of patients with hemorrhagic shock and that is why the purpose of this diploma was to present physiology and pathology of hemorrhagic shock, introduce the types of fluids for resuscitation and the effect of fluid resuscitation on improvement in patients vital signs. Which fluid should be used for this purpose has been a topic of ongoing debate for many years, yet is still little evidence to support one fluid over another. Each fluid type has specific benefits and with overloading fluids we can even cause more damage than good. That is why we presented colloids (albumin, gelatins, dextrans, and hydroxyethyl starches) versus crystalloids (saline solutions and Ringer's lactate), the structure and effects. The quantitative research data was gathered with the aid of a questionnaire and protocols. 30 questionnaires were sent to Pre-hospital Emergency Medical Unit in Slovenia, to find out about general knowledge among the medical staff (medical technician, graduate nurse) that they have on hemorrhagic shock and how often they found themselves with the patient with hemorrhagic shock in the field. With their protocols we tried to gathered information about the effects of fluids in the change in patient’s vital signs. |
