What are the indications for administering intravenous fluids in a patient with major trauma?

For patients with major trauma, intravenous (IV) fluids are indicated primarily for fluid resuscitation, especially in the presence of haemorrhagic shock ¹,².

• Haemorrhagic Shock and Traumatic Brain Injury: If haemorrhagic shock is the dominant condition, restrictive volume resuscitation should continue ¹. However, if a traumatic brain injury is the dominant condition, a less restrictive volume resuscitation approach should be used to maintain cerebral perfusion ¹.
• Fluid Replacement in Active Bleeding:
  • In pre-hospital settings, crystalloids should only be used to replace fluid volume in patients with active bleeding if blood components are not available ¹.
  • In hospital settings, crystalloids should not be used for patients with active bleeding ¹. For adults (16 or over) with active bleeding, a ratio of 1 unit of plasma to 1 unit of red blood cells should be used for fluid volume replacement ¹. For children (under 16), a ratio of 1 part plasma to 1 part red blood cells, based on the child's weight, should be used ¹. Hospital trusts should also have specific major haemorrhage protocols ¹.
• General Indicators for Urgent Fluid Resuscitation (applicable to major trauma): A patient may need urgent fluid resuscitation if they show indicators of hypovolaemia, including ²:
  • Systolic blood pressure less than 100 mmHg ².
  • Heart rate more than 90 beats per minute ².
  • Capillary refill time more than 2 seconds, or cold peripheries ².
  • Respiratory rate more than 20 breaths per minute ².
  • A National Early Warning Score (NEWS) of 5 or more ².
  • Passive leg raising suggests fluid responsiveness ².

IV fluid therapy should only be provided when a patient's needs cannot be met by oral or enteral routes, and it should be stopped as soon as possible ².