Page 21 - ATP-P 11th Ed

e. Fluid Resuscitation
i. Assess for hemorrhagic shock (altered mental status in the absence of brain
injury and/or weak or absent radial pulse).
ii. The resuscitation fluids of choice for casualties in hemorrhagic shock, listed SECTION 1
from most to least preferred, are:
(a) Cold stored low titer O whole blood
(b) Pre-screened low titer O fresh whole blood
(c) Plasma, red blood cells (RBCs) and platelets in a 1:1:1 ratio
(d) Plasma and RBCs in a 1:1 ratio
(e) Plasma or RBCs alone
NOTE: Hypothermia prevention measures should be initiated while fluid resus-
citation is being accomplished.
(a) If not in shock:
• No IV fluids are immediately necessary.
• Fluids by mouth are permissible if the casualty is conscious and can
swallow.
(b) If in shock and blood products are available under an approved command
or theater Blood Product Administration Protocol:
• Resuscitate with cold stored low titer O whole blood, or, if not available
• Pre-screened low titer O fresh whole blood, or, if not available
• Plasma, RBCs, and platelets in a 1:1:1 ratio, or, if not available
• Plasma and RBCs in a 1:1 ratio, or, if not available
• Reconstituted dried plasma, liquid plasma or thawed plasma alone or
RBCs alone
• Reassess the casualty after each unit. Continue resuscitation until a pal-
pable radial pulse, improved mental status or systolic BP of 100mmHg
is present.
• Discontinue fluid administration when one or more of the above end
points has been achieved.
• If blood products are transfused, administer 1g of calcium (30mL of 10%
calcium gluconate or 10mL of 10% calcium chloride) IV/IO after the
first transfused product.
(c) Given increased risk for a potentially lethal hemolytic reaction, transfu-
sion of unscreened group O fresh whole blood or type specific fresh whole
blood should only be performed under appropriate medical direction by
trained personnel.
(d) Transfusion should occur as soon as possible after life-threatening hemor-
rhage in order to keep the patient alive. If Rh negative blood products are
not immediately available, Rh positive blood products should be used in
hemorrhagic shock.

10 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 11