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In the field of the fluid resuscitation there are numerous issues that are debated for decades now. Most of these unresolved issues reflect upon decision-making process of the prehospital care provider. In short period of time he has to decide, if there is a need for fluid resuscitation, how much fluid is needed, how fast is fluid needed. He will also have to decide what kind of fluid to use. ... It is aimed more to point out the questions and problems which are facing prehospital provider.
Do we need prehospital fluid resuscitation?
Fluid resuscitation in field was until recently unchallenged recommendation and practice. Laboratory studies of hemorrhagic shock using traditionally, models of controlled hemorrhage have led to the current Advanced Trauma Life Support guidelines for fluid resuscitation: administer 2 L of lactated Ringers solution and then consider transfusing blood. ... Unfortunately, there are patients who do not respond to this resuscitation regimen and, in fact, get worse. Unlike laboratory animals, in which fluid resuscitation begins after hemorrhage has stopped, patients may have ongoing hemorrhage. Increasing blood pressure with fluid resuscitation may increase bleeding.
In an editorial asking "Are victims of injury sometimes victimized by attempts at fluid resuscitation?", Bickell challenged what he terms our "current conceptualization of the pathophysiology of hemorrhagic hypotension" and the effects of IV fluid therapy: patients who survive aggressive IV fluid infusions have benefited from this practice, and those who expire are labeled "irreversible." Aggressive fluid resuscitation may be undesirable in the presence of an uncontrolled or noncompressible vascular injury. ... Hypotensive patients who had suffered penetrating torso injuries were randomized to receive either no fluid or standard fluid resuscitation before induction of anesthesia. Survival was greater in the delayed resuscitation group. ... Interestingly, the authors found greater benefit of delayed fluid resuscitation in the more severely injured patients, who probably did have UHS. ... 12 were able to show better survival in a group with larger fluid volume given. ...
Beside the volume the rate and timing of the resuscitation seems important. ... These patients may have significant ongoing blood loss during fluid resuscitation. ... They found that aggressive fluid resuscitation with either normal saline or hypertonic saline increased bleeding, but improved survival, compared with no treatment or small-volume resuscitation.
Approximate Word count = 1745
Approximate Pages = 7
(250 words per page double spaced)
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