05/21/2026
Answers - When you detect poor volume as shown, what is your next step before volume resuscitation and restoration with crystalloids?
1) You must answer the question: "where is the "leak" in the tank?" In other words, where is the volume loss? Is the poor LV cardiac filling from external losses like gastrointestinal losses, vomiting/diarrhea, or massive external hemorrhage? Is it from internal losses like ascites, retroperitoneal effusion, pleural effusion, within the gastrointestinal tract or uterus that can be detected using AFAST®, part of Global FAST®? Or is the internal hemorrhage from a major long bone or pelvic fracture site?
Clinical signs, physical examination findings, and Global FAST® findings help with answering the mandated question of where is the intravascular loss?
If you stop at the heart, and don't consider where the "leak" in the tank is and load the patient with intravenous fluids not knowing that the patient is hemorrhaging in its abdominal cavity, then hopefully you will figure that out before the patient worsens or even codes, because likely the volume restoration will exacerbate the intraabdominal bleeding.
