Recommendations run contrary to current teaching
BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e7211 (Published 30 October 2012) Cite this as: BMJ 2012;345:e7211
- Jai Chitnavis, honorary consultant trauma and orthopaedic surgeon
- jaichitnavis{at}hotmail.com
In support of hypovolaemic resuscitation of trauma patients, the authors cite National Institute for Health and Clinical Excellence guidance stipulating that “no fluid be administered in the prehospital resuscitation phase if a radial pulse can be felt, or for penetrating trauma if a central pulse is palpable.”1
Such advice runs contrary to current teaching on the management of haemorrhagic shock in both prehospital and advanced trauma life support manuals,2 3 both of which advocate initial fluid therapy.
The authors’ recommended management of severely injured patients with “permissive hypovolaemia” is not commonly practised.
They state that a 3:1 ratio of crystalloid volume replacement for blood loss was promoted in the 1960s and 1970s. I would like to remind them that such advice is still part of current advanced trauma life support teaching.3
What should we be doing for haemorrhagic shock in trauma?
Notes
Cite this as: BMJ 2012;345:e7211
Footnotes
Competing interests: None declared.