Normal Saline Use In Trauma Patients

1529 words - 7 pages

For decades prehospital providers have been treating trauma patients by initiating intravenous access and administering crystalloid fluids. The debate has been over what crystalloid fluid to administer for volume replacement, at what amount, and if we should be administering fluids at all. Many products are available and much research has been conducted with results showing that not all fluids are created equal. Some products have the ability to replace volume but provide little more benefit and may actually be harmful. Other products, when administered at much lower volumes, provide far greater benefits and greater potential for a positive outcome for the patient. Most ground ambulances ...view middle of the document...

So do we want to raise the patient’s blood pressure back to a, so called, normal and effectively trick the body into thinking that everything is cool or should we allow the compensatory mechanisms do what they need to? Normal saline administered in large quantities over a short amount of time must not be good but that is what is taught. Two large bore intravenous lines, preferably bilaterally, running normal saline wide open right?

In a study conducted by Wenjun Z Martini entitled “Comparisons of normal saline and lactated Ringer’s resuscitation on hemodynamics, metabolic responses, and coagulation in pigs after severe hemorrhagic shock”, the effects of normal saline and Lactated Ringers were compared when used in pigs suffering from severe hemorrhage. (1) This was a small study of 20 pigs, each of which had a controlled hemorrhage of an estimated 60% of blood volume. Blood was removed via the left femoral artery of each pig. The animals were resuscitated with either Lactated Ringers or normal saline. Vital signs were measured and blood samples were drawn at baseline and after resuscitation (15 min, 3 hours, and 6 hours) to measure changes in coagulation using thrombelastography which is a method of testing the efficiency of blood coagulation. Mean Arterial Pressure was affected negatively by hemorrhage in all subjects but was returned to baseline within one hour of resuscitation with either fluid used. The volume of normal saline needed to achieve the same affects in Mean Arterial Pressure was 50% greater than that of Lactated Ringers. Of course peripheral resistance was decreased with each fluid but the greater drop was seen with normal saline. Serum potassium was not affected with Ringers Lactate but increased with use of normal saline and coagulation was similarly impaired with either fluid. Normal saline did show greater vasodilation and a higher stroke volume than Lactated Ringers which results in better Oxygen deliver and tissue perfusion. Urine output was measured and was seen to be much greater in the group which received the normal saline infusion.

This study did show that clot effectiveness was more markedly impaired in the group that received the Normal Saline but in each group clot production and efficiency was returned to normal within three hours of resuscitation. Subsequently the fact that a greater volume of normal saline (50% more) than Lactated Ringers is required to reach the same Mean Arterial Pressure or Blood Pressure the study shows that with greater hemodilution you have greater coagulation impairment. Also, this study had an unnatural control of blood loss, and most likely, survival rates in patients with uncontrolled bleeding would be greatly impaired by the administration of large quantities of normal saline. It also bears mentioning that normal saline also showed greater risks of metabolic acidosis and hyperkalemia than Lactated Ringers.

A study cited in an article called Permissive Hypotension in Trauma...

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