Prehospital Fluid Management in Hemorrhagic Shock

Hemorrhagic shock is a clinical state in which severe blood loss causes insufficient cellular oxygen delivery, leading to organ failure and, ultimately, death.1 Annually, over 60,000 deaths in the United States and some 1.9 million worldwide are due to hemorrhagic shock, with some 1.5 million of these cases associated with trauma.2,10 IV fluid resuscitation has become a staple of prehospital management of hemorrhagic shock. However, subsequent studies from both laboratory control models and post-transport patient outcomes have questioned this practice, suggesting that permissive hypotension (i.e., systolic blood pressure [SBP] of 80 mmHg or below in adults) or resuscitation with blood products leads to improved patient outcomes and survival. It’s unclear whether, despite this evolving body of work, these recommendations have been broadly adopted by civilian EMS practices in the prehospital setting. The authors surveyed the medical directors of many large EMS systems to determine whether the practice of permissive hypotension or the administration of prehospital blood products has been more widely adopted. Methods A survey was sent to the EMS medical directors of many large EMS systems (the “Eagles Coalition”) who were asked two questions: 1) Whether their system used blood or blood products during the prehospital resuscitation phase of hemorrhagic shock management; and 2) The blood pressure targets, if relevant, associated with their hemorrhagic shock resuscitation prot...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Trauma Cardiac & Resuscitation Top Story Exclusive Articles Patient Care Source Type: news