The Official Publication of ITACCS - International Trauma ...

ITACCS Spring 2003
IVF resuscitation in certain uncontrolled hemorrhage models and one major clinical study
has even shown the efficacy of withholding IVF infusions preoperatively in those patients
with penetrating torso injuries (versus the standard rapid infusions of IVF in both the prehospital
and emergency department settings). It is therefore speculated that BP elevation,
prior to achievement of hemostasis, may actually increase mortality in certain subgroups of
injury patients. The rationale, experimental evidence, scientific design, and limitations of
these studies will be examined and qualified in this discussion. In addition, the concept of
using hypertonic solutions and new hemoglobin-based oxygen carriers in such circumstances
will be analyzed as well.
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Prehospital Use of Hypertonic Saline Derivatives
Professor Pierre Carli, MD, PhD
Department of Anesthesiology, Hôpital Necker–Enfants Malades, Paris, France
Learning Objectives: 1) To understand the importance of correct assessment of the
status of trauma cases in the prehospital setting and 2) to learn the use of small-volume
hypertonic solutions in penetrating trauma for rapid fluid replacement, providing a modified
systemic arterial pressure capable of maintaining vital functions while limiting the
possibility of further hemorrhage.
Hypertonic saline solutions associated with colloids are particularly suitable for prehospital
use in major trauma.
In European EMS systems, where physicians are involved in prehospital care, three
steps of management are closely linked. First, the on-site evaluation of the patient is essential
to assess the mechanism of the injuries and the respiratory and ventilatory status. Special
care must be taken with penetrating trauma with hypotension or multiple blunt trauma with
severe brain injury because the management of these patients is different.
Second, on-site respiratory management in order to provide efficient airway ventilation
and oxygenation is the first priority of treatment. Stabilisation of respiratory status improves
patient survival. Prehospital intubation is indicated in severe trauma patients who are unconscious
(GCS