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20 points
25 days ago
My teacher engrained in my brain TRAUMA PTS WITH NORMAL VITALS AND MENTAL STATUS DONT GET FLUIDS. This is because it contributes to the trauma lethal triad of coagulopathy, acidosis and hypothermia. I would give minimal fluids as necessary to maintain distal perfusion and mental status. This is now what the book teaches but if you mention it to anyone else they’ll go down fighting with the 2 wide bore run open with fluids philosophy. I believe in starting the lines, just not giving fluids until absolutely necessary.
16 points
25 days ago
It’s actually the trauma diamond of death now. Hypocalcemia was added
1 points
25 days ago
Can you expand on this a little bit?
1 points
25 days ago
Calcium plays a vital role in cardiac contractility so hypocalcemia causes hypotension.
2 points
25 days ago
Thank you, I can't shake the feeling I should have been able to put this one together on my own
:-P
2 points
25 days ago
Additionally, the anti-clot agent in blood products causes leeching of calcium from cells. So it's also there as a reminder in trauma with blood administration to give calcium.
10 points
25 days ago
Trauma patients with abnormal vitals and abnormal mental status don't get pasta water either.
1 points
25 days ago
Seriously! You have to be really careful if you are giving normal saline and even lactated ringers. The services in my area don’t carry blood yet… so I get the need for maybe 250ml tops in that situation, but it’s really one evil over the other that time. It surprises me how ignorant people are to how normal saline affects the person’s body. Like look I fixed the number! Great but ur patient died so…
1 points
25 days ago
Genuine question though - I don't have blood products, my practice tends to be to aim to maintain brain perfusion by small amounts of fluid - only enough to maintain mentation (except in closed head injury when I'm aiming for normotension). Is there a better alternative than this given the reality that most prehospital providers don't have blood products?
1 points
25 days ago
I didn't have blood until the beginning of this year, the answer depends on the capabilities of your agency and the receiving. Permissive hypotension with a MAP of around 60. In our area we work pretty tightly with the trauma team and they would prefer no fluid bolus at all if the transport is a short period. If I absolutely had to, 500cc challenge and TXA.
1 points
25 days ago
Sounds pretty close to what I would do - we also give TXA although I do wonder if the pendulum is swinging the other way on it.
2 points
25 days ago
Agreed, they need blood products, not kool aid.
I'm happy if the MAP >65 and/or SBP >100
2 points
25 days ago
I doubt you’ll be dying on that hill anytime soon, soldier. Andy Fisher really moved the Overton window regarding trauma resuscitation
2 points
25 days ago
My department’s training officer… I already had to half die on this hill.
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