ABSTRACT
I. INTRODUCTION Fluid resuscitation of trauma patients presenting with hemorrhagic hypotension is an integral, mandatory component of the restoration of normal organ physiology. In the initial prehospital management it is important to consider the severity of the condition, the possibilities to stop or reduce blood loss, and the urgency with which to start fluid resuscitation. The following aspects of prehospital fluid resuscitation of trauma patients are fundamental (Fig. 1):
When? Indications for start of fluid therapy What? Choice of fluid How much? Monitoring and goals for the fluid resuscitation
II. WHEN? INDICATIONS FOR START OF FLUID THERAPY A. General Aspects Aggressive therapeutic measures during the first ‘‘golden hour’’ following trauma are usually considered vital for the outcome of trauma patients. In the case of a short transport
time to the nearest hospital emergency department however, the necessity of intravenous access and start of fluid resuscitation in the field may be questioned. It may be more important for survival to get the patient to the emergency department rather than delay transportation by attempts to start fluid therapy. The facilities of a hospital emergency department allow not only better resuscitation conditions but also more advanced diagnostic modalities and more prompt surgical intervention for the reduction of blood loss. In most trauma situations, however, establishing IV access and the initiation of fluid infusion as early as possible in the clinical course (i.e., in the prehospital setting) is considered essential (Fig. 1). Venous cannulation is certainly easier to perform in the early posttraumatic phase before severe hypovolemia develops than in established hypovolemic shock. In late shock, peripheral venous cutdown or central venous cannulation may be the only remaining access alternatives. Whenever possible, at least one-but preferably more than one-large-bore IV line should be established and safely secured in trauma patients, and fluid therapy should be started.
