Page 128 - Journal of Special Operations Medicine - Spring 2016

An Ongoing Series

Prolonged Field Care Working Group
Fluid Therapy Recommendations

Benjamin Baker, DO; Doug Powell, MD; Jamie Riesberg, MD; Sean Keenan, MD

ABSTRACT
The Prolonged Field Care Working Group concurs that are meant to serve as a general guide, but specific guid-
fresh whole blood (FWB) is the fluid of choice for patients ance, via telemedicine or calling for other medical con-
in hemorrhagic shock, and the capability to transfuse sultation, may be required for complicated, critically ill
FWB should be a basic skill set for Special Operations patients with prolonged evacuation times.
Forces (SOF) Medics. Prolonged field care (PFC) must
also address resuscitative and maintenance fluid require- Clinical Overview
ments in nonhemorrhagic conditions.
Fluid is administered to patients for one of three rea-
Keywords: prolonged field care; blood, fresh whole; shock, sons: as therapy, to correct pathologic fluid volume loss,
hemorrhagic; transfusion and as nutrition. Resuscitation fluid is given as therapy
to achieve either an end-organ function (e.g., increased
UOP, improved mentation) or hemodynamic improve-
ment in a patient experiencing a systemic inflammatory
Introduction
response or shock state. Organ dysfunction or hemody-
The Prolonged Field Care Working Group (PFC WG) namic compromise in these patients is due to a loss of ef-
concurs that FWB is the fluid of choice for patients in fective circulating volume. Resuscitation fluid is given to
hemorrhagic shock, and the capability to transfuse FWB restore adequate volume, generally in bolus increments,
should be a basic skill set for SOF Medics. Addition- guided by clinical end points, although certain specific
1
ally, PFC must address both resuscitative and mainte- conditions, such as rhabdomyolysis and crush injuries,
nance fluid requirements in nonhemorrhagic conditions are resuscitated with high-rate continuous infusions. 4
such as significant burns, dehydration, sepsis, and head
injury. Our goal is to inform the community through Replacement fluid is used to correct water and electro-
recommendations for premission training and logistics lyte deficits due to pathologic volume loss. Examples
and actual patient treatment in the PFC environment. include plasma loss in burns, watery diarrhea in gastro-
intestinal illness, and diabetes insipidus in head trauma.
There has been great debate regarding the use of col- Replacement fluid is generally given as a continuous in-
loids versus crystalloids; both fluid classes have advan- travascular, enteral, or per rectum (PR) infusion, or by
tages and disadvantages. The best fluid, however, is strictly scheduled oral (PO) intake. These patients may
2,3
the one you have available. not be in a systemic inflammatory or shock state, but
they are at risk of deteriorating into these states if their
Urine output (UOP) is a very easy and extremely impor- fluid losses are not replaced.
tant monitoring tool to guide fluid resuscitation and fluid
maintenance requirements. We recommend that PFC pro- Maintenance fluid is given as nutrition to provide wa-
viders be trained and equipped to accurately measure UOP. ter and electrolytes that are lost via ongoing physiologic
sweat, respiratory, urine, and stool output, as well as
The type and amount of fluids given must be tailored to glucose required chiefly for brain metabolism. The
the specific patient being treated. These recommendations body’s absolute requirement for fluid is approximately

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