Prehospital Fluid Resuscitation in the Injured Patient
Published 2009
Published 2009
(a) There is insufficient data to recommend one solution or type of fluid over other options in the prehospital setting. (b) Small volume boluses (250 mL) of 3% and 7.5% hypertonic saline (HTS) are equivalent, with respect to vascular expansion and hemodynamic changes, to large volume boluses (1 L) of standard solutions such as lactated Ringer's (LR) or 0.9% normal saline (NS).
There is insufficient data to support any recommendation at this level.
There administration of blood in the prehospital setting is safe and feasible.
No level one recommendation can be made. There is insufficient data to show that trauma patients benefit from prehospital fluid resuscitation.
(a) Intravenous fluids should be withheld in the prehospital setting in patients with penetrating torso injuries. (b) An IV placed to saline-lock is equivalent in patency and function to a continuous infusion.
(a) Intravenous fluid resuscitation should be withheld until active bleeding/hemorrhage is addressed. (b) Intravenous fluid administration in the prehospital setting (regardless of mechanism or transport time) should be titrated for palpable radial pulse using small boluses of fluid (250 mL) rather than fixed volumes or continuous administration.
No Level I recommendation can be made. There is insufficient data to support specifically where and through which approach vascular access should be obtained in the prehospital setting of trauma.
(a) If central access is necessary, the percutaneous Seldinger technique is recommended over traditional cut-down procedures as there is evidence that percutaneous techniques are quicker and have equivalent success rates. (b) The use of intraosseous access in trauma patients requiring vascular access in which intravenous access is unobtainable or has failed two attempts is recommended.
Attempts at peripheral intravenous access should be limited to two attempts during prehospital transport after which, alternative methods (intraosseous, central access) should be attempted if equipment and trained personnel are available.
No level one recommendation can be made. There is insufficient data to support a Level I recommendation for placing vascular access in the prehospital setting.
Placement of vascular access at the scene of injury should not be performed as it delays patient transport to definitive care, and there is no evidence to demonstrate any benefit to their placement.
Placement of vascular access during transport is feasible and does not delay transport to definitive care.