Guidelines for Pre-hospital Fluid Therapy in Trauma PresPresentation Transcript
Guidelines for Pre-hospital Fluid Therapy in Trauma - do we need them? Christina Carding
Summary of NICE guidelines
Summary of EAST guidelines
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”
Risks v.s Benefits
Should you give fluids?
To which patients?
If so how much?
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
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?
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
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
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.