---

drsohil, the topic certainly is live.... It certainly does give the impression that most of the topics are dying rather prematurely... wonder why?

There are a few issues here:
If there is an obvious source of external bleeding, I wouldn't be that fussed regarding fluid management. The treatment could well be 'plug the hole and fill the tank'!!! Still, there is a definite place for Perm Hypotension...

More importantly, with the above mechanism of injury, the patient may also have internal damage (liver/spleen/mesentery/pelvic organs/renal etc...). I would be vary of any such causes of shock, which would then make me think of definitely invoking 'permissive hypotension' principle. This would possibly minimise bleeding from the micro-vascular bed and also prevent coagulation discrepancies

In this patient however, his GCS is low. Has he got a significant head injury?? If there were to be any other pointers suggestive of this, I would certainly aim for a MAP >90 mmHg (to ensure adequate CPP) and thus avoid cerebral hypoxia...

At the end of the day, I feel it is more a case of balance between the various parameters.

RM