RESUMO
AIMS: The aim of this study was to investigate whether shifting the focus to solution orientation and developing coping strategies for common errors could increase the efficiency of laparoscopic training and influence learning motivation. The concept of coping has been particularly defined by the psychologist Richard Lazarus [Lazarus and Folkman in Stress, appraisal, and coping, Springer publishing company, New York, 1984]. Based on this model, we examined the use of observational learning with a coping model for its effectiveness as a basic teaching model in laparoscopic training. METHODS: 55 laparoscopically naive medical students learned a standardized laparoscopic knot tying technique with video-based instructions. The control group was only offered a mastery video that showed the ideal technique and was free from mistakes. The intervention group was instructed on active error analysis and watched freely selectable videos of common errors including solution strategies (coping model) in addition to the mastery videos. RESULTS: There was no statistically significant difference between the intervention and control groups for number of knot tying attempts until proficiency was reached (18.8 ± 5.5 vs. 21.3 ± 6.5, p = 0.142). However, there was a significantly higher fraction of knots achieving technical proficiency in the intervention group after first use of the coping model (0.7 ± 0.1 vs. 0.6 ± 0.2, p = 0.026). Additionally, the proportion of blinded attempts that met the criteria for technical proficiency was significantly higher for the intervention group at 60.9% vs. 38.0% in control group (p = 0.021). The motivational subscore "interest" of the validated score on current motivation (QCM) was significantly higher for the intervention group (p = 0.032), as well as subjective learning benefit (p = 0.002) and error awareness (p < 0.001). CONCLUSION: Using video-based learning of coping strategies for common errors improves learning motivation and understanding of the technique with a significant difference in its qualitative implementation in laparoscopy training. The ability to think in a solution-oriented, independent way is necessary in surgery in order to recognize and adequately deal with technical difficulties and complications.
Assuntos
Educação a Distância , Laparoscopia , Humanos , Técnicas de Sutura/educação , Competência Clínica , Adaptação Psicológica , Laparoscopia/educaçãoRESUMO
BACKGROUND: The aim of this study was to assess the transferability of surgical skills for the laparoscopic hernia module between the serious game Touch Surgery™ (TS) and the virtual reality (VR) trainer Lap Mentor™. Furthermore, this study aimed to collect validity evidence and to discuss "sources of validity evidence" for the findings using the laparoscopic inguinal hernia module on TS. METHODS: In a randomized crossover study, medical students (n = 40) in their clinical years performed laparoscopic inguinal hernia modules on TS and the VR trainer. TS group started with "Laparoscopic Inguinal Hernia Module" on TS (phase 1: Preparation, phase 2: Port Placement and Hernia Repair), performed the module first in training, then in test mode until proficiency was reached. VR group started with "Inguinal Hernia Module" on the VR trainer (task 1: Anatomy Identification, task 2: Incision and Dissection) and also performed the module until proficiency. Once proficiency reached in the first modality, the groups performed the other training modality until reaching proficiency. Primary endpoint was the number of attempts needed to achieve proficiency for each group for each task/phase. RESULTS: Students starting with TS needed significantly less attempts to reach proficiency for task 1 on the VR trainer than students who started with the VR trainer (TS = 2.7 ± 0.6 vs. VR = 3.2 ± 0.7; p = 0.028). No significant differences for task 2 were observed between groups (TS = 2.3 ± 1.1 vs. VR = 2.1 ± 0.8; p = 0.524). For both phases on TS, no significant skill transfer from the VR trainer to TS was observed. Aspects of validity evidence for the module on TS were collected. CONCLUSION: The results show that TS brought additional benefit to improve performances on the VR trainer for task 1 but not for task 2. Skill transfer from the VR trainer to TS could not be shown. VR and TS should thus be used in combination with TS first in multimodal training to ensure optimal training conditions.
Assuntos
Hérnia Inguinal , Cirurgiões , Realidade Virtual , Competência Clínica , Simulação por Computador , Estudos Cross-Over , Hérnia Inguinal/cirurgia , Laparoscopia , Estudantes de Medicina , Cirurgiões/educação , Jogos de Vídeo , Humanos , Masculino , Feminino , Adulto JovemRESUMO
BACKGROUND: In-bed cycling (IBC) is gaining interest for implementation in intensive care units. Our main objective was to explore patient recollections and experiences of early mobilization, including IBC. Secondly, we aimed to examine if IBC was safe and feasible. METHODS: Eleven participants were interviewed about their experiences during their critical illnesses and active mobilization in the intensive care unit. The interviews were analyzed thematically. Six participants were also monitored for physiological reactions and adverse events during IBC while mechanically ventilated. RESULTS: From the interviews, one main theme with three subthemes was identified. The main theme was: Early mobilization gave a direction toward normalization. The three subthemes were: (1) IBC gave a feeling of control over recovery early on during the critical illness (2) Early mobilization, including IBC, with continuous support from health care professionals gave a feeling of safety and hope for recovery for the patient; and (3) Unpleasant experiences and disorientation were felt during the critical illness and IBC. Furthermore, IBC did not induce large physiological changes or major adverse events in the participants who were monitored for feasibility and safety. CONCLUSIONS: Patient interviews indicated that the patients' participation in early mobilization with emphasis on IBC motivated them to be active in their recovery to regain a good level of health after their earlier critical illness during their intensive care stay. IBC was, in this small study, safe and feasible in the two participating intensive care units.
Assuntos
Deambulação Precoce , Unidades de Terapia Intensiva , Motivação , Segurança do Paciente , Adulto , Idoso , Estado Terminal , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The media thickness (m), luminal radius (r) and m/r ratio were determined in the hepatic arterial trunk and in intra-hepatic arterial branches as was the number of arteries per cm2 sectioned liver tissue in spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto controls (WKY). The cross-sectional vessel parameters were calculated for a standardized condition, in which the internal elastic membrane is smooth and circular. Both intra-hepatic arterial branches and the hepatic arterial trunk showed significantly higher m/r ratios in SHR than in WKY controls. The luminal radius of the hepatic arterial trunk was larger in SHR than in WKY (P less than 0.05). The number of arteries per cm2 sectioned liver tissue was greater in SHR (P less than 0.05). It is suggested that the consequences of the increased m/r ratio in hepatic arteries of SHR are counteracted to some extent by an increased vascularization, but that during hypovolaemia and compensatory vasoconstriction, a greater decrease in hepatic arterial blood flow occurs in SHR than in WKY.
Assuntos
Artéria Hepática/anatomia & histologia , Fígado/irrigação sanguínea , Ratos Endogâmicos SHR/anatomia & histologia , Ratos Endogâmicos/anatomia & histologia , Ratos Endogâmicos WKY/anatomia & histologia , Animais , Pressão Sanguínea , Masculino , Ratos , Especificidade da EspécieRESUMO
Hypertensive disease is known to increase the risks in connection with acute changes in blood pressure due to the presence of pronounced structural as well as functional changes in the cardiovascular system. In the present study the metabolic consequences of fixed haemorrhagic hypotension [mean arterial pressure (MAP) 70 and 45 mmHg] were studied in spontaneously hypertensive (SHR) and in normotensive rats (WKY). Blood gases and acid-base balance, blood glucose, liver (ATP, glucose, lactate) and brain (ATP, ADP, AMP, CP, glucose, lactate) metabolites were determined in unbled animals and after 35 min hypotension in bled animals. In the liver haemorrhage to MAP 70 mmHg resulted in a 70% reduction of the ATP content in SHR while that in WKY remained unchanged. At MAP 45 mmHg reduced liver ATP levels (35% reduction) were observed in WKY as well. In the brain metabolic changes indicative of tissue ischaemia (reduced CP, increased AMP and lactate, decreased energy charge potential) were present only in SHR at MAP 45 mmHg. The more pronounced metabolic disturbances in SHR than in WKY indicate that blood loss is more deleterious for the hypertensive individual.
Assuntos
Encéfalo/metabolismo , Hemorragia/complicações , Hipertensão/fisiopatologia , Hipotensão/metabolismo , Fígado/metabolismo , Animais , Glicemia/metabolismo , Hipertensão/metabolismo , Hipotensão/etiologia , Masculino , Ratos , Ratos Endogâmicos SHR , Ratos Endogâmicos WKYRESUMO
In spite of improvements in obstetric and neonatal care, hypoxic-ischemic brain damage with severe neurologic disability is still a clinical reality. A model in 7-day-old rats has been introduced to study the pathophysiology of perinatal hypoxic-ischemic brain damage. Unilateral brain damage is produced in the cerebral cortex, striatum and hippocampus, i.e. a similar distribution as is often seen in human asphyxiated neonates. In the present investigation the model was evaluated further by comparing three different methods to assess the brain damage: weighing the hemispheres, morphometry and somatosensory evoked potentials. Seven-day-old rats were subjected to unilateral carotid artery ligation followed by 2 h of hypoxia (7.7% O2 at 36 degrees C). After 2 h of hypoxic-ischemia pCO2 and pO2 decreased in mixed arterial/venous blood. The evaluation of the damage 2 weeks after the insult, demonstrated close correlation between morphometry and weighing (r = 0.836, P less than 0.01). The amplitude of evoked potentials correlated to the other parameters (r = 0.814, P less than 0.01 and r = 0.824, P less than 0.01 respectively) and displayed a greater relative attenuation than the other methods but with a more pronounced variability. These results indicate that the degree of brain damage can be assessed by weighing for screening purposes.
Assuntos
Animais Recém-Nascidos , Dano Encefálico Crônico/etiologia , Isquemia Encefálica/complicações , Hipóxia/complicações , Envelhecimento/fisiologia , Animais , Animais Recém-Nascidos/crescimento & desenvolvimento , Dano Encefálico Crônico/diagnóstico , Dano Encefálico Crônico/patologia , Potenciais Somatossensoriais Evocados , Tamanho do Órgão , Ratos , Ratos EndogâmicosRESUMO
OBJECTIVE: To evaluate the effects of prostaglandin (PG)F2 alpha on human corpus luteum (CL) function in vivo. DESIGN: The effects of a single injection of PGF2 alpha into the CL was studied. SETTING: The patients underwent elective surgery at the Department of Obstetrics and Gynecology, Sahlgrenska Hospital, University of Göteborg, Sweden. PARTICIPANTS: Twenty women with regular menstrual cycles undergoing laparoscopy for legal sterilization with tubal clips volunteered for the study. INTERVENTIONS: Prostaglandin F2 alpha (3 mg) was injected through the abdominal wall into the CL. In control cases, vehicle was injected into the CL or PGF2 alpha into the contralateral ovary. MAIN OUTCOME MEASURE: After the injections, serum was analyzed for progesterone (P) and luteinizing hormone using fluoroimmunoassay and enzyme-immunoassay, respectively. Menstrual data were recorded. RESULTS: In contrast to control cases, intraluteal injection of PGF2 alpha caused both an immediate fall of greater than 30% in serum P and a shortening of the luteal phase by 2 to 5 days. Luteinizing hormone varied independently of the changes in serum P levels. CONCLUSION: The results suggest a local role for PGF2 alpha in human luteolysis.
Assuntos
Corpo Lúteo/efeitos dos fármacos , Dinoprosta/farmacologia , Luteolíticos/farmacologia , Adulto , Corpo Lúteo/irrigação sanguínea , Feminino , Humanos , Hormônio Luteinizante/sangue , Luteólise , Progesterona/sangue , Valores de Referência , Fluxo Sanguíneo Regional/efeitos dos fármacosRESUMO
The neuroprotective effect of kynurenic acid, an unspecific antagonist of excitatory amino acid receptors, was evaluated in a model of hypoxic-ischemia in neonatal rats. One-week-old rats were subjected to ligation of the left carotid artery and exposure to 7.7% O2/92.3% N2 for 2 h. Kynurenic acid (300 mg/kg) was administered i.p. immediately after the period of hypoxic-ischemia in one group (n = 32) and compared with saline-treated (n = 27). After 2 weeks the rats were sacrificed and the brain damage evaluated by comparing the weight of the lesioned and unlesioned hemispheres. In rats receiving kynurenic acid the reduction in weight of the lesioned hemisphere was 25.4 +/- 3.3% as compared to 37.8 +/- 3.6% in saline-treated controls (P less than 0.001). The results suggest that excitatory amino acids are involved in the development of postischemic damage in the immature brain.
Assuntos
Encéfalo/fisiopatologia , Hipóxia/tratamento farmacológico , Ataque Isquêmico Transitório/tratamento farmacológico , Ácido Cinurênico/uso terapêutico , Animais , Encéfalo/efeitos dos fármacos , Edema Encefálico/tratamento farmacológico , Edema Encefálico/etiologia , Transtornos Cerebrovasculares/tratamento farmacológico , Transtornos Cerebrovasculares/etiologia , Feminino , Hipóxia/complicações , Hipóxia/mortalidade , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/mortalidade , Ácido Cinurênico/administração & dosagem , Masculino , Tamanho do Órgão , RatosRESUMO
The cardiovascular changes during epidural caesarean delivery were studied, using a non-invasive cardiac output monitor (BoMed NCCOM3-R7). Two different regimens were used to control hypotension (A = 15 ml/kg of 3% dextran 70, B = 7.5 ml/kg of 3% dextran 70 followed by an infusion of 17.5 mg of ephedrine). Cardiac index (CI) and heart rate (HR) increased after delivery and oxytocin administration (P < 0.001) and maximum values were recorded 1-1.5 min after administration of oxytocin. The maximum increase in CI was 76% (A) and 117% (B), in HR 42% (A) and 56% (B), and in SI 23% (A) and 47% (B) compared with values before anaesthesia. The increase in cardiac output after delivery was greater than that measured previously, which might be because impedance cardiac output is a continuous method. It is also suggested that the most pronounced changes are augmented by the use of a bolus injection of 10 units oxytocin i.v.
Assuntos
Incisivo/lesões , Osteíte/diagnóstico , Tecido Periapical , Descoloração de Dente/etiologia , Criança , Seguimentos , HumanosAssuntos
Anestesia Geral/efeitos adversos , Diabetes Insípido/complicações , Complicações Intraoperatórias/etiologia , Complicações Pós-Operatórias/etiologia , Idoso , Diabetes Insípido/metabolismo , Diabetes Insípido/fisiopatologia , Feminino , Humanos , Complicações Intraoperatórias/metabolismo , Complicações Intraoperatórias/fisiopatologia , Complicações Pós-Operatórias/metabolismo , Complicações Pós-Operatórias/fisiopatologia , Neoplasias Retais/cirurgiaRESUMO
OBJECTIVE: This survey estimated differences in staff time requirements between fentanyl HCl iontophoretic transdermal system (fentanyl ITS) and intravenous patient-controlled analgesia (IV-PCA) in post-operative pain management. RESEARCH DESIGN AND METHODS: European Delphi panels of nurses and anaesthesiologists, who had practical experience with both fentanyl ITS and IV-PCA, were provided a task list, developed from a previous clinical trial, associated with each modality. The panellists were asked to estimate time spent on each task. Estimates were calculated by multiplying the estimated patient proportion for whom the task was performed by the expected frequency of task performance, by the estimated task time. RESULTS: Data is presented as mean minutes (standard deviation). Fentanyl ITS use was estimated to save an average of 68.7 min total staff time per patient per treatment period compared to IV-PCA (86.5 (20.3)) vs. 156.4 (55.2); respectively; p < 0.001), the largest amount of savings being in the 'Setup' category (19.4 (6.7) vs. 47.8 (17.5), respectively; p < 0.001), and mostly due to IV-PCA task elimination. Significant time savings were estimated using fentanyl ITS over IV-PCA in the 'Discontinuation' category (4.8 (2.4) vs. 20.6 (3.3), respectively; p < 0.001). Panellists agreed that fentanyl ITS use would decrease staff assistance time required for helping patients during self-care routines and it may also decrease the patient's time to ambulation. Survey limitations included: possible recall bias due to the observational nature of the data; task list descriptions resulting in possible double-counting of data; no sensitivity analyses; and the declarative nature of the responses possibly leading to a dilution of survey findings. CONCLUSIONS: Fentanyl ITS use was estimated, by expert opinion, to require 44% less staff time than IV-PCA use.
Assuntos
Analgesia Controlada pelo Paciente , Analgésicos Opioides/uso terapêutico , Fentanila/uso terapêutico , Pessoal de Saúde , Morfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Administração Cutânea , Analgésicos Opioides/administração & dosagem , Coleta de Dados , Técnica Delphi , Fentanila/administração & dosagem , Humanos , Morfina/administração & dosagemRESUMO
This report describes a new case of adamantinoma of the tibia which is a rare primary malignant bone tumour. Just over 100 cases have been reported. The symptoms, treatment and problems of diagnosis are briefly discussed.
Assuntos
Ameloblastoma/diagnóstico , Neoplasias Ósseas/diagnóstico , Tíbia , Idoso , Ameloblastoma/patologia , Ameloblastoma/cirurgia , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Humanos , MasculinoRESUMO
In order to evaluate experimentally if the presence of hypertensive disease is an additional risk factor in connection with emergency situations including blood loss, awake spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto rats (WKY) were subjected to standardized acute haemorrhage (35% of blood volume) via an aortic catheter. Mean arterial blood pressure (MAP), blood gases, acid-base balance, blood glucose and haematocrit values were followed and the 5-h survival rate was determined. In the early posthaemorrhagic phase similar plasma refill, as evidenced from haematocrit readings, was seen in SHR and WKY. Hyperglycaemia occurred in both groups but the hyperglycaemic response was only moderate and transient in SHR. The inability of SHR to maintain hyperglycaemia was intimately correlated to early appearance of metabolic acidosis and short posthaemorrhagic survival times. Determination of liver glycogen content of unbled SHR and WKY indicated that the deficient hyperglycaemic response in SHR was not due to inadequate glycogen stores but rather to poor liver perfusion resulting in liver hypoxia. Since spontaneous hypertension in rats in many ways is considered to be similar to essential hypertension in man, these findings suggest that human hypertensive disease constitutes a considerable risk factor in connection with acute haemorrhage.
Assuntos
Hemorragia/fisiopatologia , Hipertensão/fisiopatologia , Equilíbrio Ácido-Base , Anestesia Geral , Animais , Gasometria , Glicemia/metabolismo , Pressão Sanguínea , Hematócrito , Glicogênio Hepático/metabolismo , Masculino , Ratos , Ratos Endogâmicos SHR , Ratos Endogâmicos WKYRESUMO
Blood loss has previously been shown to be more detrimental for spontaneously hypertensive (SHR) than for normotensive Wistar-Kyoto (WKY) rats. To evaluate whether this decreased tolerance to blood loss is due to disturbances in circulatory control or to alterations in cellular function caused by the hypertensive disease, SHR and WKY were subjected to complete liver ischaemia. During a 45-min period of ischaemia as well as after 4 h of reflow, the liver content of ATP, glycogen, glucose and lactate was determined. Liver ATP decreased to 15% and liver glycogen to 30% of initial levels, while liver glucose increased 6-fold and liver lactate 13-fold during the ischaemic period in both SHR and WKY. Following 4 h of reflow, ATP was restored to 11.5 +/- 1.7 mumol X g protein-1 (56% of initial level) in SHR and to 15.2 +/- 1.3 (76%) in WKY. The levels of lactate and glucose returned to control levels after the reflow period while the glycogen stores were further depleted in SHR as well as WKY. No difference between SHR and WKY in cellular metabolic function during the ischaemic period could thus be demonstrated, and the postischaemic recovery was not significantly different. It is concluded that hypertensive disease does not seem to change the ischaemic tolerance of liver cells to any considerable extent.
Assuntos
Hipertensão/complicações , Isquemia/complicações , Fígado/irrigação sanguínea , Animais , Suscetibilidade a Doenças , Metabolismo Energético , Hipertensão/metabolismo , Fígado/metabolismo , Masculino , Ratos , Ratos Endogâmicos SHR , Ratos Endogâmicos WKYRESUMO
BACKGROUND: Whereas induction and recovery will occur more rapidly with the new low soluble anaesthetics than with isoflurane, the quality of anaesthesia and recovery with special emphasis on postoperative nausea and vomiting (PONV) is not well known. METHODS: In an open (peroperatively), double-blinded (postoperatively), randomised controlled study, we assessed anaesthesia characteristics, recovery and 24 h PONV after breast surgery comparing isoflurane, desflurane and sevoflurane. RESULTS: There were no significant quality differences between the three agents during anaesthesia and recovery except for the incidence of PONV in the postanaesthesia care unit (PACU). The PONV rate (24 h in PACU and ward) was higher in the desflurane group (67%) than in the isoflurane group (22%), (P<0.01). The corresponding PONV rate for sevoflurane was 36%. CONCLUSION: The quality of anaesthesia, time to opening of eyes and influence on respiration was similar with all three anaesthetics. As the emergence from anaesthesia did not differ significantly between the three agents, the choice of agent could be based on PONV rate and price. Desflurane had a significantly higher 24 h PONV rate than isoflurane. Early PACU PONV rate was significantly (P<0.05) lower for the more soluble isoflurane (4%) than for the low soluble gases, desflurane and sevoflurane together (28%). The result of this study does not give a rationale for a transition to the new low soluble agents in breast cancer surgery.
Assuntos
Período de Recuperação da Anestesia , Anestesia por Inalação , Anestésicos Inalatórios , Mama/cirurgia , Náusea e Vômito Pós-Operatórios , Desflurano , Método Duplo-Cego , Feminino , Hemodinâmica , Humanos , Isoflurano/análogos & derivados , Éteres Metílicos , Pessoa de Meia-Idade , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Respiração , SevofluranoRESUMO
Using a non-invasive cardiac output monitor (Bo-Med NCCOM 3-R7), we have compared cardiovascular responses, degree of haemodilution and incidence of nausea during extradural Caesarean section in healthy non-labouring mothers given either ephedrine 17.5 mg and 3% Dextran 70 7.5 ml kg-1 before delivery (group A) or volume loading with Dextran 15 ml kg-1 without infusion of ephedrine (group B). Smallest systolic arterial pressures before delivery were 114 (SEM 4) mm Hg (group A) and 105 (5) (group B). There were no significant differences between the groups in mean arterial pressure, heart rate, systemic vascular resistance or central venous pressure, while cardiac output increased more with the ephedrine infusion (P less than 0.05). Haemodilution was 8% in group A and 16% in group B at the time of delivery. Ephedrine infusion was associated with a smaller incidence of nausea (P less than 0.01). Umbilical arterial pH values were not different between the two groups. We conclude that infusion of ephedrine, combined with low volume colloid administration, is a safe alternative to more extensive colloid volume expansion for control of hypotension and provides effective prophylaxis against nausea during extradural Caesarean section in healthy non-labouring mothers.
Assuntos
Anestesia Epidural/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Cesárea , Dextranos/uso terapêutico , Efedrina/uso terapêutico , Hipotensão/prevenção & controle , Adulto , Coloides , Feminino , Sangue Fetal/química , Hemodinâmica/efeitos dos fármacos , Humanos , Hipotensão/etiologia , Náusea/etiologia , Náusea/prevenção & controle , GravidezRESUMO
The spontaneously hypertensive rat (SHR) has a deficient glucose mobilization in response to blood loss. Treatment of blood loss with hypertonic glucose might consequently be advantageous in SHR, but the importance of osmolality as compared to ionic composition of resuscitation fluids is still not fully elucidated. Therefore, SHR (n = 32) were subjected to hemorrhage (30% of calculated blood volume) followed by treatment with (1) hypertonic saline (HS; 4.5 ml/kg of 7.5% NaCl, 2,400 mOsm/L), (2) hypertonic glucose (HG; 4.5 ml/kg of 42.3% solution, 2,400 mOsm/L), and (3) normal saline (NS; 37.5 ml/kg of 0.9% NaCl) to provide an equal sodium load as with HS. All fluid regimens increased (P < 0.001 vs. control) mean arterial pressure (MAP). Hemodilution was more pronounced after HS and NS than after HG. Hypernatremia was evoked by HS. The hyperglycemic response to hemorrhage was intensified by HG, but it was accompanied by increased blood lactate levels. All three treatment regimens prolonged posthemorrhagic times until death (P < 0.01-0.05) (mean values: NS 363 min; HS 170 min; HG 146 min; nontreated controls 60 min). It is concluded, on the basis of hemodynamic, metabolic, and times-until-death data, that although treatment with small-volume HS seems superior to small-volume HG, an equal load of sodium given as NS is more effective for resuscitation after blood loss than HS in SHR.