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1、CHAPTER5SHOCK,ELECTROLYTES,ANDFLUIDPeterRheevariables.Becausesurgeonscanonlycontroltheintravascularhistoryspace,thischapterwillconcentrateonthecorrectmanagementphysiologyofshockoftheintravascularspace,becausethisistheonlymeanstoresuscitationcontroltheothertwofluidcompartments.periope
2、rativefluidmanagementThischapterwillalsoexaminehistoricalaspectsofshock,electrolytesfluids,andelectrolytes—notjusttonoteinterestingfactsorpaytributetodeservingphysicians,butalsototrytounderstandhowthisknowledgewasgained.Doingsoisvitaltounderstand-ingpastchangesinmanagementandtoaccept
3、futurechanges.Surgeonsarethemastersoffluidsbecausetheyneedtobe.TheySurgeonsareoftenawedatthediscoveriesmade,yetalsocareforpatientswhocannoteatordrinkforvariousreasons—astoundedbyhowoftentheywerewrong,andwhy.Futureforexample,theyhavehemorrhaged,undergonesurgery,orlostsurgeonswilllookb
4、ackatthecurrentbodyofknowledgeandfluidsfromtubes,drains,orwounds.Surgeonsareobligatedtobeamazedathowlittlewasknown.Recentchangesintheman-knowhowtocareforthesepatients,astheyhaveputtheirlivesagementofshock,fluids,andelectrolyteshavebeenmajorones.inourhands.Thistopicmightappearsimpleon
5、lyforthosewhoKnowledgeofthehistoryhelpsexplainwhythesechangesweredonotunderstandthecomplexitiesofthehumanbodyanditsrequired.Asaconsequenceofnotstudyingthepast,wehaveabilitytoregulateandcompensatefluids.Inreality,thetaskofoftenrepeatedhistoryinmanyways.managingpatients’bloodvolumeison
6、eofthemostchallengingAfterthehistoricalhighlights,thischapterwilldiscussburdenssurgeonsface,oftenrequiringcompletecontrolofthefluidsthatarenowused,alongwithfluidsunderdevelopment.intakeandoutputoffluidsandelectrolytes,ofteninthepresenceFinally,caringforperioperativepatientswillbeexpl
7、oredfromaofbloodloss.Surgeonsdonotyetcompletelyunderstandthedailyneedsperspective.physiologyofshockandresuscitation,andourknowledgeissuperficial.Giventhenatureofourprofession,wehavestudiedHISTORYfluidsandelectrolytesaswedealtwithpatientswhohavebledHistorymaybedislikedbythosewhoareina
8、hurrytolearn
