Prehospital fluid resuscitation of the patient with major trauma

Paul E. Pepe, Vincent N. Mosesso, Jay L. Falk

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

The most appropriate prehospital approach to resuscitative fluid interventions for trauma patients involves: Determining the mechanism of injury (i.e., blunt versus penetrating versus thermal injury); identifying anatomic involvement (i.e., truncal versus isolated head injury versus isolated extremity injury); and staging the condition (i.e., hemodynamic stability versus instability versus moribund state). Based on available data, the liberal use of fluid infusions for presumed uncontrolled internal hemorrhage, such as that usually occurring after penetrating abdominal and thoracic injuries, is no longer advised. Although some infusion might be appropriate in patients with extremely severe hemorrhage (i.e., no palpable blood pressure, unconscious), the priority in such patients is rapid evacuation to definitive surgical intervention, with airway control and intravenous access provided en route. The data are less clear for patients with blunt injuries, particularly those with closed head injury. Most researchers would still recommend that patients with isolated extremity and head injuries, either blunt or penetrating, are candidates for immediate support of blood pressure through fluid infusions. However, the addition of potential intra-abdominal, intrapelvic, or intrathoracic injuries with uncontrolled hemorrhage confounds the decision-making process. Although conventional wisdom has been to provide aggressive blood pressure support under these circumstances through judicious use of isotonic, or perhaps hypertonic, fluid resuscitation, recent experimental data challenge even this philosophy. Use of new blood substitutes might help to resolve some of these issues by providing oxygen delivery with limited volume in the face of uncontrolled hemorrhage.

Original languageEnglish (US)
Pages (from-to)81-91
Number of pages11
JournalPrehospital Emergency Care
Volume6
Issue number1
StatePublished - 2002

Fingerprint

Resuscitation
Hemorrhage
Wounds and Injuries
Closed Head Injuries
Nonpenetrating Wounds
Blood Pressure
Penetrating Head Injuries
Extremities
Blood Substitutes
Abdominal Injuries
Thoracic Injuries
Airway Management
Craniocerebral Trauma
Decision Making
Hot Temperature
Hemodynamics
Research Personnel
Oxygen

Keywords

  • Blood substitute
  • Blunt injury
  • Head injury
  • Hemoglobin-based oxygen carrier
  • Hemorrhage
  • Injury
  • Intravenous fluid
  • Penetrating injury
  • Resuscitation
  • Shock
  • Trauma

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Pepe, P. E., Mosesso, V. N., & Falk, J. L. (2002). Prehospital fluid resuscitation of the patient with major trauma. Prehospital Emergency Care, 6(1), 81-91.

Prehospital fluid resuscitation of the patient with major trauma. / Pepe, Paul E.; Mosesso, Vincent N.; Falk, Jay L.

In: Prehospital Emergency Care, Vol. 6, No. 1, 2002, p. 81-91.

Research output: Contribution to journalArticle

Pepe, PE, Mosesso, VN & Falk, JL 2002, 'Prehospital fluid resuscitation of the patient with major trauma', Prehospital Emergency Care, vol. 6, no. 1, pp. 81-91.
Pepe, Paul E. ; Mosesso, Vincent N. ; Falk, Jay L. / Prehospital fluid resuscitation of the patient with major trauma. In: Prehospital Emergency Care. 2002 ; Vol. 6, No. 1. pp. 81-91.
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