Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Hemostatic Resuscitation by Richard Dutton, MD

There is a longer than usual video at EMCrit, but it is worth watching more than once. Dr. Dutton explains about the use of fluids in resuscitation.

Hemostatic Resuscitation by Richard Dutton, MD

We all have our biases. Dr. Dutton does a good job of pointing out those of others, but one that seems to affect Dr. Dutton is the Maryland helicopter system. He does not see that the fly everyone and let ShockTrauma sort them out approach, that was so vigorously defended by Dr. Thomas Scalea, is not supported by any evidence.

After the protocols were changed to cut the flights by about half, there does not appear to have been any change in the outcomes of trauma patients in Maryland.

Dr. Scalea promised us dead bodies galore, but he has not delivered.

It appears that this extreme approach of Dr. Scalea is unjustified, yet Dr. Dutton seems to have unrestricted praise for the Maryland system of flying everyone.

Back to the video. Dr. Dutton points out problems with resuscitation research that has similarly focused only on the extremes –

Unrestricted fluids to keep the blood pressure high (at least triple digits).

vs.

No fluids to allow the body to stabilize on its own.

Dr. Dutton points out that a Goldilocks amount of fluid resuscitation may may exist between these extremes. There are a bunch of studies used to support this. There appear to be big problems with giving too much fluids and with giving the wrong fluids.

We should not be giving fluids that make clotting less effective do not clot or carry oxygen. Updated 08:23 6/12/11.

What do we give in EMS?

Crystyalloids.

What do do crystalloids to to coagulation?

They make it worse.

What volumes do we give in EMS?

Often we give all we can possibly force into any hypotensive patient who is still bleeding. Just to try to make the blood pressure look better. We generally can make the blood pressure look better.

Does this improve survival?

No.

Go watch the video to learn a lot more.

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