Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For patients with major trauma, intravenous (IV) fluids are indicated primarily for fluid resuscitation, especially in the presence of haemorrhagic shock NICE NG39,NICE CG174.
- Haemorrhagic Shock and Traumatic Brain Injury: If haemorrhagic shock is the dominant condition, restrictive volume resuscitation should continue NICE NG39. However, if a traumatic brain injury is the dominant condition, a less restrictive volume resuscitation approach should be used to maintain cerebral perfusion NICE NG39.
- 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 NICE NG39.
- In hospital settings, crystalloids should not be used for patients with active bleeding NICE NG39. 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 NICE NG39. 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 NICE NG39. Hospital trusts should also have specific major haemorrhage protocols NICE NG39.
- General Indicators for Urgent Fluid Resuscitation (applicable to major trauma): A patient may need urgent fluid resuscitation if they show indicators of hypovolaemia, including NICE CG174:
- Systolic blood pressure less than 100 mmHg NICE CG174.
- Heart rate more than 90 beats per minute NICE CG174.
- Capillary refill time more than 2 seconds, or cold peripheries NICE CG174.
- Respiratory rate more than 20 breaths per minute NICE CG174.
- A National Early Warning Score (NEWS) of 5 or more NICE CG174.
- Passive leg raising suggests fluid responsiveness NICE CG174.
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 NICE CG174.