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Prehospital Fluid

Garth Melnick gmelnick at efn.org
Sat Apr 7 17:46:13 BST 2012

Hi all,

I know, I know, this is a very dead horse. But I have a slightly 
different angle on it this morning.

I'm an ambulance paramedic; I also work on a small team providing 
wilderness ALS care. Often we have prolonged evac / transport times. I 
recently ran across the recommendations of the International Commission 
for Mountain Rescue on fluid resuscitation.

They're here: http://bit.ly/HSPa56

Interestingly, in the setting of PROLONGED prehospital time and a 
patient with suspected TBI (GCS <9), this committee recommends 
resuscitating pts to >110mmHg for cerebral perfusion. Otherwise the 
target is 90mmHg. They note pts with suspected ongoing hemorrhage should 
be maintained at a lower SBP.

I'm curious what the experts here think. I know the consensus is 
restricted fluids prehospital and a target SBP of 90mmHg. How does a 
serious TBI change that? How does a 6 hour – or 24 hour – prehospital 
time change that?



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