Letters Early fluid resuscitation in severe trauma

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
  1. Jai Chitnavis, honorary consultant trauma and orthopaedic surgeon
  1. 1Cambridge University Hospitals NHS Trust, Cambridge CB2 2QQ, UK
  1. 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?


Cite this as: BMJ 2012;345:e7211


  • Competing interests: None declared.


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