is “don’t pop the clot” by the use of excessive
IV fluid in the field. For patients with internal
bleeding who aren’t in uncompensated shock
(their systolic BP is greater than 80–90 mm/
Hg, or a radial pulse is present and mentation is normal), IV fluids should be withheld
until the patient can receive definitive control of this internal hemorrhage in the operating room.
photo courtesy peter taillac
Resuscitation studies demonstrate that
this strategy minimizes hemorrhage and
subsequent transfusion requirements.
However, in the case of a patient who is
demonstrating signs of uncompensated
shock (systolic BP is less than 80–90, or the
patient has a loss of radial pulse or decreas-
ing mentation), administration of judicious
boluses of crystalloid to support the blood
pressure may be required to get the patient
to the ED alive. Administration of boluses
of 500–1,000 cc at a time, with reassess-
ment after each bolus to keep the systolic
BP above 80–90 mm/Hg is recommended.
This strategy of minimizing IV fluid by
such calibrated boluses is contrasted with
vider must alert the ED personnel that a tour-
niquet is in place, so it isn’t overlooked while
the other, more obvious, wounds are man-
aged. If a pressure dressing is placed, then
the tourniquet should be left loosely in place
and the thigh wound frequently re-evaluated
by the EMS provider for continued bleeding.
Then, if bleeding recurs, the tourniquet can
then be simply re-tightened.
Tourniquets can be an effective treatment for
hemorrhage control for extremity wounds, such
as this one, which required amputation.
Research indicates that this clot formation is
disrupted by rapidly increasing the BP with
crystalloid IV fluids, such as normal saline.
In addition, crystalloid dilutes the clotting
factors that are critical to formation and
strengthening of these fragile clots. Based
on this research, the new recommendation
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