6
30-45 minutes IM
More effective titration of dosage
Decreases chance of accidental overdose
Give IV if corpsman available
Emphasize
contraindications
No Fluid Resuscitation for Uncontrolled Hemorrhage
Fluid Resuscitation in Uncontrolled Hemorrhage
Previous standard: 2 liters LR or NS for hypovolemia
The beneficial effect from crystalloid and colloid fluid resuscitation in hemorrhagic
shock has been demonstrated largely on animal models where the volume of hemorrhage is
controlled experimentally and resuscitation is initiated after the hemorrhage has been stopped.
Controlled versus uncontrolled hemorrhage
Ben Taub Study
Large prospective trial
598 patients with penetrating torso trauma and hypotension
Aggressive preoperative fluid resuscitation resulted in a survival rate of
62%.
No aggressive fluid replacement until the time of operative
intervention resulted in significantly higher survival rate of 70%
Bickell et al NEJM 1993
Fluid Resuscitation in Uncontrolled Hemorrhage
Later overruled by expert panel at Mogadishu TCCC Workshop
Hetastarch for Fluid Resuscitation
Why Hetastarch instead of Lactated Ringer's or normal saline?
Lactated
Ringers
Give
1000cc
1 hour later only 200cc left in circulation
Hetastarch (hextend and Hespan)
Give
1000cc
8 hours later still have 1600cc left in circulation
Special Forces After-Action
Fluid resuscitation with hetastarch effective for 5 hours+
