Pre-hospital fluids - when and how much?

Abstract

When to give intravenous fluids, how much to give and whether intravenous fluids improve patient outcome remain controversial areas. Hypovolaemic shut down patients are difficult to connulate. The on scene is protracted and invariably relatively small volumes of fluid are infused. Those patients who are hypotensive invariably require definitive surgical intervention, therefore, any delay in reaching hospital can worsen outcome. Intravenous fluids given in states of uncontrolled and noncompressible bleeding will enhance blood loss. There is therefore a need to define those patient groups requiring pre-hospital intervention and optimal recusitation objectives in terms of blood pressure in the pre-hospital scene. This paper examines the current evidence base in both animal and human trials and makes recommendations for optimal fluid management in the trauma patient.