40 % Loss of blood volume in a patient is Managed by-

Initial resuscitation requires rapid reexpansion of the circulating intravascular blood volume along with interventions to control ongoing losses. In accordance with Starling's law stroke volume and cardiac output rise with the increase in preload. After resuscitation, the compliance of the ventricles may remain reduced due to increased interstitial fluid in the myocardium. Therefore, elevated filling pressures are frequently to maintain adequate ventricular performance. Volume resuscitation is initiated with the rapid infusion of either isotonic saline (although care must be taken to avoid hyperchloremic acidosis from loss of bicarbonate buffering capacity and replacement with excess chloride) or a balanced salt solution such as Ringer's lactate (being cognizant of the presence of potassium and potential renal dysfunction) through large-bore intravenous lines. Data, paicularly on severe traumatic brain injury (TBI), regarding benefits of small volumes of HYPEONIC SALINE that more rapidly restore blood pressure are variable, but tend to show improved survival thought to be linked to immunomodulation. No distinct benefit from the use of colloid has been demonstrated, and in trauma patients it is associated with a higher moality, paicularly in patients with TBI. The infusion of 2-3 L of salt solution over 20-30 min should restore normal hemodynamic parameters. ref:harrison&;s principles of internal medicine,ed 18,pg no 2221