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Guidelines for Pre-hospital Fluid Therapy in Trauma Pres
Guidelines for Pre-hospital Fluid Therapy in Trauma Pres
Guidelines for Pre-hospital Fluid Therapy in Trauma Pres
Guidelines for Pre-hospital Fluid Therapy in Trauma Pres
Guidelines for Pre-hospital Fluid Therapy in Trauma Pres
Guidelines for Pre-hospital Fluid Therapy in Trauma Pres
Guidelines for Pre-hospital Fluid Therapy in Trauma Pres
Guidelines for Pre-hospital Fluid Therapy in Trauma Pres
Guidelines for Pre-hospital Fluid Therapy in Trauma Pres
Guidelines for Pre-hospital Fluid Therapy in Trauma Pres
Guidelines for Pre-hospital Fluid Therapy in Trauma Pres
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Guidelines for Pre-hospital Fluid Therapy in Trauma Pres

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  • 1. Guidelines for Pre-hospital Fluid Therapy in Trauma - do we need them? Christina Carding
  • 2. Content
      • Introduction
      • Summary of NICE guidelines
      • Summary of EAST guidelines
      • Overall conclusions
      • References
  • 3. Introduction
      • Currently a lack of evidence demonstrating a benefit of prehospital fluid resuscitation
      • Fluid resuscitation is considered to be standard of care.
      • There has been an increase in the number of prehospital procedures over the last 10 years.
      • “ scoop and run” v.s “Stay and play”
  • 4. Risks v.s Benefits
  • 5. NICE guidelines
    • 7 studies
      • Should you give fluids?
      • To which patients?
      • If so how much?
      • What type?
  • 6. NICE guidelines
      • IV fluids should not be administered if a radial pulse can be felt in blunt injuries (or for penetrating torso injuries, if a central pulse can be felt)
      • ADULTS - in the absence of a radial pulse fluids should be administered in boluses of ≤250ml. Patient reassessed and process repeated until radial pulse felt
      • CHILDREN - insufficient evidence
      • Administration of fluid should not delay transport to hospital
      • Crystalloid solution is recommended
  • 7. EAST guidelines
    • 42 studies
      • Should injured patients have vascular access attempted prehospital?
      • What location is preferred for access?
      • Should IV fluids be administered?
      • Which solution is preferable?
      • At what volume and rate?
  • 8. EAST guidelines
      • Venous access attempted at the scene delays transport - placement of access should be enroute. Intraosseous access can be attempted
      • No preferred access site
      • Patients with penetrating injury and short transit time (<30 mins) – fluids should be withheld in prehospital setting if palpable brachial pulses
      • Fluids should only be given:
    • In 250ml boluses
    • To return the patient to coherent mental status
    • To return palpable radial pulses
      • Patients with traumatic brain injury – fluids titrated to maintain systolic BP >90mmHg or mean pressure >60mmHg
      • 0.9% sodium chloride is recommended
      • Rapid infusion systems and or pressurised devices should not be used
  • 9. Summary
      • Insufficient evidence that blunt or penetrating trauma patients benefit from prehospital fluid resuscitation if a brachial pulse is palpable
      • In the absence of a brachial pulse fluid should be administered in 250ml boluses with continual reassessment
      • If suspected head injury fluid should be administered cautiously as above
      • Normal saline is recommended
  • 10. References
      • EAST practice parameter workgroup for prehospital fluid resuscitation 2009. Guidelines for prehospital fluid resuscitation in the injured patient. The Journal of TRAUMA injury, infection, and critical care August 2009;67,2: 389-402.
      • NICE January 2004. Pre-hospital initiation of fluid replacement therapy in trauma. National Institute for Clinical Excellence, Technology Appraisal 74.
  • 11.  

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