Hi,
All the evidence from both UK and USA appears to show that infusing fluids pre surgery in
a patient with uncontrolled severe haemorrhage kills people- maintaining an uneccesarily
high bp simply leads to more bleeding. Here we teach AB + control of external haemorrhage
on scene, cannulate in vehicle, infuse,if necessary, to maintain a radial pulse(syst. bp > 80)
at a rate of < 110-120. This is so called permissive hypotension as practiced by Champion,
Mattox, Porter etc.. The cannula should be the biggest you can get in ,wherever you can
get it in- the people who need it most are always hardest so if need be a small venflon in
the back of the hand is ok as a start!
John Hall
GP
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