Guidelines for Pre-hospital Fluid Therapy in Trauma Pres

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Guidelines for Pre-hospital Fluid Therapy in Trauma Pres

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

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