The fluids of choice in prehospital field are, in most cases, cristalloids (Norma Saline or Lactate Ringer).
But what is the physiological impact of saline solutions when administered in large amounts (as the latest ATLS guidelines indicates) to hypotensive trauma patients?
Is aggressive Fluid resuscitation the right strategy to be pursued?
The triad of post-trauma lethal evolution is:
Aggressive fluid resuscitation with cristalloids, and saline solutions in particular, can be detrimental in many ways:
- Cristalloids tend to displace the already formed clots and improves bleeding
- Normal Saline produce hypercloremic acidosis worsening coagulation and precipitating renal and immune dysfunction
- Cristalloids diluts the coagulation factors and precipitate the coagulation system (dilution coagulopathy)
- Cristalloids rapidilly shift in intercellular space worsening SIRS process and interstitial edema (brain edema, bowel wall edema) with consequent compartment hypertension
So wich is the perfect fluid to infuse in trauma?
The perfect fluid doesn’t exists.
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