is anyone here... hypertonic saline for the treatment of trauma

[Smash]

The only place i see the use is military. (hextend) we use a 6% solution... I would love to see it on the civilian side

Why?

 

[EMT11KDL]

Why?

Being able to give a pt smaller amount of fluid... Ie like hextend if i give 500ml it will end up increasing the fluid to 750ml in the cardiovascular system.. With a max of 1000ml. Maybe 1500 ml depending on how the patient presents after the first 1000. Its an easy way to help reduce the likely hood of shock and bring pressure us without having to make koolaid of the blood.

 

[zmedic]

In the military the advantage of volume expanders is you don't have to carry as much. It's much easier to have your medic carry 500ccs of something than 2 liters of it. I'd also point out that I'm very suspicious of military research, as most of their patients are very healthy 20 year olds. I'm never sure how much that data transfers to my stateside population. Ie just because 20 year olds can handle factor 7 without too many strokes, I don't think my 60 year old who just fell down the stairs is in the same category.

The best thing for people who are bleeding out is blood. And in most places in the US, you can get your trauma patient to the ER pretty quickly. So the patient should be able to get O negative fairly rapidly. As others have said, these patient's problem isn't really blood pressure. You can survive with a pretty low MAP. It's lack of oxygen and CO2 carrying capacity.

 

[Smash]

Being able to give a pt smaller amount of fluid... Ie like hextend if i give 500ml it will end up increasing the fluid to 750ml in the cardiovascular system.. With a max of 1000ml. Maybe 1500 ml depending on how the patient presents after the first 1000. Its an easy way to help reduce the likely hood of shock and bring pressure us without having to make koolaid of the blood.

I appreciate the rationale, but the point is that there isn't any particularly compelling evidence that hypertonic solutions confer any benefit to the patient. That being the case, it doesn't seem like a good use of money to stock anything other than NaCl or LR. Given your enthusiasm I thought you may have been aware of some research that demonstrated benefit.

Zmedic makes some valid points, particularly with the weight aspect and military medicine, however this doesn't really apply to civilian EMS (possibly some Rambo Ambo, whoops, I mean tactical medic, might need it)
Ultimately if we need to replace red stuff we should be using red stuff (or parts thereof)

 

[mycrofft]

If volume loss is through an open conduit, I fail to see where simply attracting fluid back to the conduit system will help. Recruiting fluids that way just lines them up for the egress into the autotransfusor or onto the floor (or into the third-spaces).

I'm not sure if hypertonic solution will recruit much fluid through normal vascular conduit walls. Not supposed to. Maybe if they are teetering on the edge of collapse due to third-spacing plasma/serum, or due to poison or anaphylaxis.

Don't hypertonic salt solutions have the potential for cautery or at least vein irritation?

If something works on the battlefield as a hasty expedient measure and can be more-conveniently stored than blood, and it does't trash outcomes in the Role 3, then use it in that setting. If something does not work in the ED, then stop using it there.

Hospital retrospective studies should be to prospect for areas to fix or areas to see what's going right. Due to variances in related care, overall technique and staffing, there are too many confounders. The ED might actually be a better setting due to very limited number of potential caregivers. Devil is in the other presenting problems, such as alcoholism, concurrent trauma, etc.

 

[mycrofft]

One of the true advantages of EMTLIFE: FEEDBACK!

One of my mentors points out the advantages sought by reducing the absolute volume of infused fluids through hypotonic recruitment of other fluids, thus addressing the issues of over-voluming the pt (And maybe also "diluting them pink"...the blood that is, not their skin color).

Thanks!

 

[EMT11KDL]

I have used it for trauma. Yes main reason for needing is a compromised system. But you should be addressing that issue. Also lr and nacl is great to carry. I come from a military back ground where we try to do a lot with very little. And on the civilian side we should have kinda the same attitude.

With military im happy with q pressure above 80. and yes most pt i get r in there 20's and healthy but they have an increased chance of very serious injuries and my job is to stabilize and prep the pt for the best chance of survival. And volume loss is the number 1 cause of death and the number 1 most preventable if treated rapidly and correctly

 

[gumby4532]

I believe Northern California (?) was testing 7.5% Saline with Dextran, a HIGH hypertonic solution with osmotic and oncotic pull for trauma patients. I heard it had very positive results on the patients. But this is something that was passed through the grapevine to me.