Fluid management of the trauma patient

Hemodynamic instability in the trauma patient is most commonly secondary to blood loss and the accumulation of fluid in injured tissue. The etiologies of shock unrelated to hypovolemia must also be investigated. The treatment of hypovolemia in patients with non-cerebral trauma should begin with Ringer's lactate solution. Normal saline (0.9% sodium chloride) is appropriate for patients with head injury, alkalosis, or hyponatremia, but in large volumes may lead to metabolic acidosis. The role of colloids, hypertonic saline, and hemoglobin solutions in trauma resuscitation is unclear at the present time. Base deficit and lactate levels are useful as predictors of morbidity and mortality and can be used to guide resuscitation.