Document Detail

Pre-hospital fluid therapy in the critically injured patient--a clinical update.
MedLine Citation:
PMID:  16098325     Owner:  NLM     Status:  MEDLINE    
Venous access and fluid therapy should still be considered to be essential elements of pre-hospital advanced life support (ALS) in the critically injured patient. Initiation of fluid therapy should be based on a clinical assessment, most importantly the presence, or otherwise, of a radial pulse. The goal in penetrating injury is to avoid hypovolaemic cardiac arrest during transport, but at the same time not to delay transport, or increase systolic blood pressure. The goal in blunt injury is to secure safe perfusion of the injured brain through an adequate cerebral perfusion pressure, which generally requires a systolic blood pressure well above 100 mmHg. Patients without severe brain injury tolerate lower blood pressures (hypotensive resuscitation). Importantly, using systolic blood pressure targets to titrate therapy is not as easy as it seems. Automated (oscillometric) blood pressure measurement devices frequently give erroneously high values. The concept of hypotensive resuscitation has not been validated in the few studies done in humans. Hence, the suggested targeted systolic blood pressures should only provide a mental framework for the decision-making. The ideal pre-hospital fluid regimen may be a combination of an initial hypertonic solution given as a 10-20 minutes infusion, followed by crystalloids and, in some cases, artificial colloids. This review is intended to help the clinician to balance the pros and cons of fluid therapy in the individual patient.
Eldar Søreide; Charles D Deakin
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Publication Detail:
Type:  Journal Article; Review     Date:  2005-04-19
Journal Detail:
Title:  Injury     Volume:  36     ISSN:  0020-1383     ISO Abbreviation:  Injury     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-08-15     Completed Date:  2005-12-05     Revised Date:  2007-04-16    
Medline Journal Info:
Nlm Unique ID:  0226040     Medline TA:  Injury     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1001-10     Citation Subset:  IM    
Division of Acute Care Medicine, Stavanger University Hospital, Stavanger, Norway.
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MeSH Terms
Blood Pressure / physiology
Blood Substitutes / therapeutic use
Brain Injuries / therapy
Colloids / therapeutic use
Critical Illness
Emergency Medical Services / methods*
Fluid Therapy / methods*
Hypotension / therapy
Isotonic Solutions / therapeutic use
Life Support Care / methods*
Rehydration Solutions / therapeutic use
Resuscitation / methods
Saline Solution, Hypertonic / therapeutic use
Wounds and Injuries / therapy*
Wounds, Nonpenetrating / therapy
Wounds, Penetrating / therapy
Reg. No./Substance:
0/Blood Substitutes; 0/Colloids; 0/Isotonic Solutions; 0/Rehydration Solutions; 0/Saline Solution, Hypertonic; 0/crystalloid solutions
Comment In:
Injury. 2007 Jan;38(1):130-1; author reply 131-2   [PMID:  16996064 ]

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