Standard Monitoring

Parameters that should be routinely monitored during resuscitation of acute hemorrhage include vital signs, mentation, skin temperature, capillary refill, oxygen saturation of arterial blood, and urine output. There is a tendency to follow BP quite closely and to gauge the adequacy of therapy by the extent to which BP returns to normal levels. It is important to recognize, however, that BP is not precisely correlated with cardiac output and provides a poor assessment of the state of cellular metabolism.2 Also, as noted below, restoration of normotension in the presence of a vascular injury may merely increase the severity of hemorrhage. Central venous pressure (CVP) monitoring may be of some value in confirming the diagnosis of hypovolemia and judging the response to therapy. A low CVP (<5 cmH 2O) supports the diagnosis of hypovolemia; probably more useful, a failure of the CVP to increase after fluid infusion suggests persistent hypovolemia and indicates the need for further fluid. Swan-Ganz catheterization is usually not necessary in the acute setting except in elderly patients or those with respiratory or cardiac disease.

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Dealing With Back Pain

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