Remplissage vasculaire: Un document à méditer !
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NICE has issued preliminary recommendations on the pre-hospital initiation of fluid replacement therapy in trauma for consultation. The guidance covers the management of adults with trauma injury in whom there is evidence of obvious or probable blood loss. It does not cover the management of isolated closed head injury.
1. It is recommended that in the pre-hospital management of adults with trauma injuries, intravenous fluid (IV fluid) should not be administered if a radial pulse can be felt (or, for penetrating torso injuries, if a central pulse can be felt).
2. In the absence of a radial pulse (or a central pulse for penetrating torso injuries), it is recommended that IV fluid in boluses of no more than 250 ml should be administered, followed by reassessment until a radial (or central) pulse is palpable.
3. The administration of IV fluid should not delay transportation to hospital, but when given in accordance with 2 above, administration may take place en route to hospital.
4. It is recommended that crystalloid solutions should normally be administered in the pre-hospital setting.
5. There is inadequate evidence, and a lack of professional consensus, on which to base recommendations on the pre-hospital use of IV fluid in children with trauma injury. However, it is recommended that the general principles for IV fluid administration in children should be based on those recommended for adults. Thus, in children considered to be at risk of hypovolaemia, IV fluids should be administered in aliquots with frequent re-assessment of the child's physiological state and transfer to hospital should not be delayed.
6. It is recommended that only paramedics or other healthcare professionals who have been appropriately trained in advanced life-support techniques and pre-hospital care should administer IV fluid therapy to trauma patients in the pre-hospital setting and that training should incorporate the above recommendations.