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Wed May 2 15:48:31 BST 2007

In a message dated 5/2/2007 5:47:26 A.M. Central Daylight Time,  
rfsmithmd at comcast.net writes:

Dr.  Mattox, why do you say no to fluid bolus in this particular  scenario?
Single stab wound to heart; pt. crashing with presumed  tamponade.

R. Smith

What this patient needs is an incision in the chest, either up and down or  
left anterolateral.   If the surgeon desires and is more comfortable  for 
exposure, then a clamshell is appropriate.    Pushing blood  and fluid are time 
wasting temporarizing efforts only and have their own  complications.    In my 
view, I see NO indication ever to give  crystalloid fluid boluses in the trauma 
patient.   That is an old  urban legend, and one that carries its own set of 
unfavorable  complications.    Blood and plasma boluses are a different thing,  
but it takes a while to get such products, and in the patient described, that 
 time is too long.   CUT.  

k

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