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Fluid resuscitation in bleeding trauma patient: are you aware of wich is the right fluid and the right strategy?
23 AprThe fluids of choice in prehospital field are, in most cases, cristalloids (Norma Saline or Lactate Ringer).
But what is the physiological impact of saline solutions when administered in large amounts (as the latest ATLS guidelines indicates) to hypotensive trauma patients?
Is aggressive Fluid resuscitation the right strategy to be pursued?
The triad of post-trauma lethal evolution is:
Aggressive fluid resuscitation with cristalloids, and saline solutions in particular, can be detrimental in many ways:
So wich is the perfect fluid to infuse in trauma?
The perfect fluid doesn’t exists.
Balanced saline and Hypertonic saline are promisng prospective but there are still no good quality evidences about their benefit on clinical outcomes.
Colloids has no place in fluid resuscitation of trauma patients.
The fluid of choice, regarding the actual evidences and indications, is Lactate Ringer.
More than on the type of fluid the attention of researchers and clinicians is oriented on the strategy to pusue in those cases.
Hypotensive resuscitation, part of damage control resuscitation, is at the moment the strategy of choice in trauma bleeding patients.
Restrictive fluids administration is the way to achieve this goal.
The target systolic BP has to be diferentiated depending on the type of trauma
More important do not delay definitive treatment.
ASAP give blood products (PRBC, FFP etc…) to contrast post-trauma coagulopathy and send the patients in OR to fix treatable causes of bleeding
The following are a collection of un essentials resources on haemostatic resuscitation after trauma
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Tag:fluids, trauma, trauma coagulopathy