Few topics in EMS generate as much debate as fluid resuscitation. Should relative hypotension be allowed? If so, in which patient population? Should you aggressively push fluids in blunt trauma or chest trauma? The debates and the data are endless. This article will not join the debate, but will provide information on different types of fluids commonly and not so commonly used for resuscitation, as well as options that may be forthcoming in the near future.

Evolution of the debate

   According to shock researcher Dr. Frederick Moore, et al, advances in shock resuscitation have occurred during military conflict as a result of concentrated experience with patients.¹ Shock resuscitation is an obligatory intervention that with refinement has changed the epidemiology of deaths from trauma. During World War I, as a result of the wound toxin hypothesis, no preoperative resuscitation was administered and many soldiers died. In World War II and the Korean conflict, due to the misconception over hemoconcentration, colloids were administered and eventually banked blood resuscitation became standard care. Early survival improved, but many casualties died later due to acute renal failure. During the Vietnam War, with the recognition that extracellular fluid space had to be repleted, large-volume isotonic crystalloid solutions replaced colloids for initial shock resuscitation. Mortality rates and the incidence of acute renal failure decreased, but adult respiratory distress syndrome emerged as a major source of morbidity and mortality.¹ Through the 1970s and early 1980s, intensive care units were developed, where advanced technology and improved care allowed patients with single organ failure to survive for long periods. Patients no longer died of acute renal failure or adult respiratory distress syndrome, but developed multiple organ failure, which, at that time, was usually fatal.

Fluid Resuscitation Options

Blood Products

   Blood is a composition of cells traveling in fluid. The cells are erythrocytes (red blood cells), leukocytes (white blood cells) and thrombocytes (platelets). The fluid is plasma. Also circulating in this fluid are proteins, hormones and other substances. A mature red blood cell consists of a membrane surrounding a liquid solution of hemoglobin, an iron-containing protein that gives blood its red color. The primary function of hemoglobin is to transport oxygen to the body tissues and remove carbon dioxide from them. White blood cells maintain immunity, and platelets form clots. Donated blood is typically broken down into the component parts for storage, namely packed red blood cells, plasma and platelets.