Three Reasons Not to Use Normal Saline or Crystalloids in Trauma

You're responding to a gunshot wound. When you arrive, you find a young man has been shot in the chest, and has significant hemorrhage. As you load him into the ambulance, your partner tells you he is spiking a 1-liter bag of 0.9% sodium chloride, also known as normal saline (NS).  You're curious, because the patient is hemorrhaging blood, not salt water, and ask why you’re not prepping blood products instead. Your partner responds, “Because it’s something we can give him now, and it helps with circulation.” But, does it actually help? This review provides historical information and research with the aim of making a case against the use of NS, and why the word “normal” may be a misnomer. This can be applied to all crystalloids or clear fluid with regard to trauma resuscitation. The goal of this article is to illustrate the many deficiencies of administering NS in a trauma patient, and to encourage critical thinking regarding current fluid resuscitation strategies that discuss increasing support for the use of blood components, including whole blood (WB). History of Crystalloids NS has existed in some form for nearly 200 years, largely tracing its roots back to the European cholera pandemic of 1831.1 But the solutions that were used in this outbreak, and for several decades of medicine thereafter, bear little resemblance to the modern mixture we use, both in content and in appropriate use.2 The first recorded experiment in modern IV fluid therapy is believed t...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Trauma Patient Care Source Type: news