Resuscitation fluid for a patient with head injury and hypovolemic shock

The resuscitation of a patient with severe closed head injury and hypovolemic shock is a commonly encountered clinical scenario. The optimal resuscitation formula remains controversial. Aggressive use of crystalloid solutions may worsen brain injury. Early use of mannitol or hypertonic agents may worsen hemorrhage and shock. The optimal approach to the resuscitation of a patient with head trauma and hypovolemic shock is reviewed and discussed. Recent experimental evidence suggests that the early inclusion of an agent such as mannitol in the resuscitation formula may be appropriate despite the evidence of shock. However, the controversy remains unresolved.