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. 1994 Sep;11(3):154–157. doi: 10.1136/emj.11.3.154

AB or ABC: pre-hospital fluid management in major trauma.

C D Deakin 1, I R Hicks 1
PMCID: PMC1342420  PMID: 7804578

Abstract

Pre-hospital trauma care in the United Kingdom is a neglected field with little consideration being given to this phase. Of the 14,500 annual fatalities from road traffic accidents in this country, 60% die before reaching hospital and it has been estimated that one-third of these fatalities are due to hypovolaemia. The pre-hospital fluid resuscitation of trauma patients is a controversial area and although it would seem sensible to commence intravenous (i.v.) fluids at the roadside, several large studies have failed to show any benefit from this intervention. By delaying departure to hospital, initiation of i.v. fluid replacement may actually worsen outcome. This paper reviews recent studies and discusses current thought on pre-hospital fluid replacement in major trauma.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson I. D., Woodford M., de Dombal F. T., Irving M. Retrospective study of 1000 deaths from injury in England and Wales. Br Med J (Clin Res Ed) 1988 May 7;296(6632):1305–1308. doi: 10.1136/bmj.296.6632.1305. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Champion H. R., Sacco W. J., Carnazzo A. J., Copes W., Fouty W. J. Trauma score. Crit Care Med. 1981 Sep;9(9):672–676. doi: 10.1097/00003246-198109000-00015. [DOI] [PubMed] [Google Scholar]
  3. Clevenger F. W., Yarbrough D. R., Reines H. D. Resuscitative thoracotomy: the effect of field time on outcome. J Trauma. 1988 Apr;28(4):441–445. doi: 10.1097/00005373-198804000-00004. [DOI] [PubMed] [Google Scholar]
  4. Copass M. K., Oreskovich M. R., Bladergroen M. R., Carrico C. J. Prehospital cardiopulmonary resuscitation of the critically injured patient. Am J Surg. 1984 Jul;148(1):20–26. doi: 10.1016/0002-9610(84)90284-8. [DOI] [PubMed] [Google Scholar]
  5. Daly K. E., Thomas P. R. Trauma deaths in the south west Thames region. Injury. 1992;23(6):393–396. doi: 10.1016/0020-1383(92)90015-k. [DOI] [PubMed] [Google Scholar]
  6. Gervin A. S., Fischer R. P. The importance of prompt transport of salvage of patients with penetrating heart wounds. J Trauma. 1982 Jun;22(6):443–448. doi: 10.1097/00005373-198206000-00001. [DOI] [PubMed] [Google Scholar]
  7. Jacobs L. M., Sinclair A., Beiser A., D'Agostino R. B. Prehospital advanced life support: benefits in trauma. J Trauma. 1984 Jan;24(1):8–13. doi: 10.1097/00005373-198401000-00002. [DOI] [PubMed] [Google Scholar]
  8. Kaweski S. M., Sise M. J., Virgilio R. W. The effect of prehospital fluids on survival in trauma patients. J Trauma. 1990 Oct;30(10):1215–1219. doi: 10.1097/00005373-199010000-00005. [DOI] [PubMed] [Google Scholar]
  9. Lewis F. R., Jr Prehospital intravenous fluid therapy: physiologic computer modelling. J Trauma. 1986 Sep;26(9):804–811. doi: 10.1097/00005373-198609000-00005. [DOI] [PubMed] [Google Scholar]
  10. Mattox K. L., Bickell W. H., Pepe P. E., Mangelsdorff A. D. Prospective randomized evaluation of antishock MAST in post-traumatic hypotension. J Trauma. 1986 Sep;26(9):779–786. doi: 10.1097/00005373-198609000-00002. [DOI] [PubMed] [Google Scholar]
  11. McSwain N. E., Timberlake G. A. Controversial issues in prehospital care. Top Emerg Med. 1987 Apr;9(1):1–11. [PubMed] [Google Scholar]
  12. O'Gorman M., Trabulsy P., Pilcher D. B. Zero-time prehospital i.v. J Trauma. 1989 Jan;29(1):84–86. [PubMed] [Google Scholar]
  13. Pepe P. E., Bass R. R., Mattox K. L. Clinical trials of the pneumatic antishock garment in the urban prehospital setting. Ann Emerg Med. 1986 Dec;15(12):1407–1410. doi: 10.1016/s0196-0644(86)80928-3. [DOI] [PubMed] [Google Scholar]
  14. Pons P. T., Moore E. E., Cusick J. M., Brunko M., Antuna B., Owens L. Prehospital venous access in an urban paramedic system--a prospective on-scene analysis. J Trauma. 1988 Oct;28(10):1460–1463. doi: 10.1097/00005373-198810000-00009. [DOI] [PubMed] [Google Scholar]
  15. Reines H. D., Bartlett R. L., Chudy N. E., Kiragu K. R., McKnew M. A. Is advanced life support appropriate for victims of motor vehicle accidents: the South Carolina Highway Trauma Project. J Trauma. 1988 May;28(5):563–570. doi: 10.1097/00005373-198805000-00001. [DOI] [PubMed] [Google Scholar]
  16. Smith J. P., Bodai B. I., Hill A. S., Frey C. F. Prehospital stabilization of critically injured patients: a failed concept. J Trauma. 1985 Jan;25(1):65–70. doi: 10.1097/00005373-198501000-00011. [DOI] [PubMed] [Google Scholar]
  17. Smith J. P., Bodai B. I. The urban paramedic's scope of practice. JAMA. 1985 Jan 25;253(4):544–548. [PubMed] [Google Scholar]
  18. Spaite D. W., Tse D. J., Valenzuela T. D., Criss E. A., Meislin H. W., Mahoney M., Ross J. The impact of injury severity and prehospital procedures on scene time in victims of major trauma. Ann Emerg Med. 1991 Dec;20(12):1299–1305. doi: 10.1016/s0196-0644(05)81070-4. [DOI] [PubMed] [Google Scholar]

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