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Tue Jun 5 23:36:49 BST 2007

Congratulations Karim on a fascinating article (and good to see you briefly in London at BAEM a few weeks ago). 

Interesting trying to integrate this with minimum volume resus stuff
a) IV fluids causes increased hydrostatic forces, dilutional coagulopathy etc etc, leading to increased bleeding and increased mortality
b) no IV fluids maintains shock, promotes coagulopathy, increased bleeding, increased mortality etc

Perhaps this is the underlying explanation why prehospital interventions in general seem not to improve outcomes - ie there is only downside whatever you do.

To me, this article helps justify the concept that the key to survival must be control of hemorrhage (by whatever means). Without this, shock and treatment of shock are both bad.

Cheers

Steve

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