Trauma Resuscitation — Circulation: Fluid Guidelines for Rapid Administration — Clinical Pathway: Emergency

Trauma Resuscitation Clinical Pathway — Emergency Department

Circulation: Fluid Guidelines for Rapid Administration

Goals

  • Recognize and treat hemorrhagic shock
  • Apply direct pressure to obvious hemorrhage
  • Follow IV escalation plan
  • Use blood products and rapid infusion early
  • Consider Massive Transfusion Protocol
  • Review other causes of shock if poor response (tension/hemothorax, cardiac tamponade/injury, severe abdominal trauma etc.)
Fluid Type Rapid Fluid Administration Volume Comments
Warmed Isotonic Crystalloid Solution
NS or LR
  • Push-Pull Technique (< 50 kg)
    • 30 mL syringe
    • Macrodrip with 3-way stopcock
    • T-connector
  • Pressure bag (≥ 50 kg)

  • Rapid infuser (≥ 50 kg)
 20 mL/kg
  • Administer blood rather than crystalloid if hemorrhagic shock is obvious
  • Monitor response:
    • Improved mental status
    • HR trending to normal range
    • Capillary refill < 2 seconds
    • Good peripheral pulses, skin color, temperature
  • Repeat as clinically indicated
    • Escalate to blood quickly (can be before crystalloid) if concern for hemorrhagic shock
Warmed O negative or type-specific warmed PRBC’s 10-20 mL/kg
  • Administer immediately if hemorrhagic shock is obvious
  • Administer quickly if condition deteriorates and/or signs of shock continue after first crystalloid bolus
  • Consider initiation of massive transfusion procedure if response to initial colloid resuscitation is poor. See Massive Transfusion in a Hemorrhaging Patient Procedure
    • Specify if you are requesting FFP & Platelets (2:1:1)