Prehospital fluid resuscitation in trauma

The indications for and type and amount of fluid resuscitation for trauma patients in the field remains highly controversial. There is unanimity, however, that trauma victims may suffer from acute blood loss. In addition to stopping the bleeding fluid resuscitation is the second mainstay in shock therapy. The insertion of 1 or 2 large-bore i.v. lines is indicated for manifest or threatening shock.Patients without signs of bleeding or hemorrhagic shock do not require fluid replacement therapy. Blood losses from bleeding that has ceased or has been stopped by compression or self-tamponade should be substituted. In uncontrolled bleeding from intraabdominal, pelvic or other internal sources immediate transport to a trauma center is required. In such situations many experts favour a goal-oriented approach of permissive hypotension aiming at a systolic blood pressure of 70-90 mmHg. In patients with severe traumatic brain injury a goal-oriented fluid resuscitation (mean arterial blood pressure of 90 mmHg) is presently recommended. Additional doses of catecholamines may be needed.Crystalloids are the recommended choice of fluid. In the presence of a suspected blood loss of more than 2 L the additional administration of colloids is suggested. However, the impact of colloids and of hyperosmolar colloid solutions with regard to survival of traumatized patients has not yet been determined.