Fluid Management in Traumatic Shock

Abstract

Fluid Management in Traumatic Shock: A Practical Approach for Mountain Rescue

Official Recommendations of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)

Günther Sumann,1,2 Peter Paal,2 Peter Mair,2 John Ellerton,3 Tore Dahlberg,4 Gregoire Zen-Ruffinen,5 Ken Zafren,6 and Hermann Brugger7

Sumann, Günther, Peter Paal, Peter Mair, John Ellerton, Tore Dahlberg, Gregoire Zen-Ruffinen, Ken Zafren, and Hermann Brugger. Fluid management in traumatic shock: a practical approach for mountain rescue. High Alt. Med. Biol. 10:71–75, 2009.—The management of severe injuries leading to traumatic shock in mountains and remote areas is a great challenge for emergency physicians and rescuers. Traumatic brain injury may further aggravate outcome. A mountain rescue mission may face severe limitations from the terrain and required res- cue technique. The mission may be characterized by a prolonged prehospital care time, where urban traumatic shock protocols may not apply. Yet optimal treatment is of utmost importance. The aim of this study is to es- tablish scientifically supported recommendations for fluid management that are feasible for the physician or paramedic attending such an emergency. A nonsystematic literature search was performed; the results and rec- ommendations were discussed among the authors and accepted by the International Commission for Moun- tain Emergency Medicine (ICAR MEDCOM). Diagnostic and therapeutic strategies are discussed, as well as limitations on therapy in mountain rescue. An algorithm for fluid resuscitation, derived from the recommen- dations, is presented in Fig. 1. Focused on the key criterion of traumatic brain injury, different levels of blood pressure are presented as a goal of therapy, and the practical means for achieving these are given.

Key words: fluid therapy; hemorrhage; mountain rescue; shock; trauma

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