Blood donor’s criteria include age 18–55 years, weight more than 45 kg, no medical illness, not on any medications, and able to understand and give inform consent. We included subjects that followed the blood donor’s criteria set by the blood bank unit. Blood donors were identified by the blood bank staff, and all the necessary tests were carried out according to the blood bank protocol. Further approval was obtained from the head Department of Hematology for the conduct of the study within the blood bank unit which was under their jurisdiction. The study was approved by the institution board review and hospital ethics committee (USMKK/PPP/JEPeM. This was a cross-sectional, prospective, observational study, conducted on volunteers who attended the blood bank unit of a tertiary teaching university hospital for blood donations over a 3-month period in 2012. We hope the result from this study will enhance the process of reaching accurate diagnosis of early hypovolemic phase and facilitate the initiation of definitive management and treatment in hoping to reduce the mortality and morbidity, either in post-traumatic condition or in any bodily fluid-deprived condition. The best replication of type I hypovolemia in a controlled environment is among blood donors. We hypothesise that there is a significant change in the ratio of IVCD to the AAD (IVCD:AAD) before and after 450 to 500 ml of blood loss (class 1 hypovolemic shock). However, the purpose of our study is mainly to develop a new approach in identifying hypovolemic shock at an early phase (class 1 hypovolemic shock) by measuring the ratio between inferior vena cava diameter (IVCD) and abdominal aortic diameter (AAD) using ultrasound machine. The 1.5 to 2 l of fluid loss is equivalent to class II to class III hypovolemia or 30 to 40 % fluid loss. They were then rehydrated with 1.5 to 2 l of fluid. In that study, 52 volunteers aged between 20 and 25 had their IVC and aorta diameter measured before any intervention. Among the earliest study to assess the IVC:AA index in hypovolemia is carried out by Kosiak et al. Unfortunately, evidence based on this topic is very scarce. It is in this regard we propose the use of the inferior vena cava to abdominal aortic (IVC:AA) diameter index as a new and relevant tool in emergency department (ED) to assess hypovolemia in its early stage. The early, non-invasive and bedside investigation will enhance the effective management and hence better clinical outcome. The outcome of patients in traumatic shock depends significantly on the early detection of hypovolemia, early fluid resuscitation and definitive corrective measure of the source of bleeding. Thus, the above parameters should not be relied heavily in clinical approach. Laboratory parameters such as metabolic acidosis, high urea level and haemoconcentration are neither non-sensitive nor specific. Furthermore, the presence of documented hypotension, tachycardia or signs of tissue hypo perfusion are insufficient to confirm the diagnosis of hypovolemia as they are non-specific. Commonly the classical clinical features of hypovolemia are absence in the early phase of hemorrhagic shock. Hypovolemia results in a reduction of systemic venous return, causing reduction in the stroke volume, which is responsible for the decrease in cardiac output. The mortality and morbidity are mainly attributed to hypovolemic shock. Trauma is the leading cause of mortality and morbidity in the reproductive age group.
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