https://deployedmedicine.com/content/134
Hemorrhagic shock in combat trauma remains the greatest life threat to casualties with potentially survivable injuries. Advances in external hemorrhage control and the increasing use of damage control resuscitation have demonstrated significant success in decreasing mortality in combat casualties. Presently, an expanding body of literature suggests that fluid resuscitation strategies for casualties in hemorrhagic shock that include the prehospital use of cold-stored or fresh whole blood when available, or blood components when whole blood is not available, are superior to crystalloid and colloid fluids.
On the basis of this recent evidence, the Committee on Tactical Combat Casualty Care (TCCC) has conducted a review of fluid resuscitation for the combat casualty who is in hemorrhagic shock and made the following new recommendations:
(1) cold stored low-titer group O whole blood (CS-LTOWB)has been designated as the preferred resuscitation fluid, with fresh LTOWB identified as the first alternate if CS-LTOWB is not available;
(2) crystalloids and Hextend are no longer recommended as fluid resuscitation options in hemorrhagic shock;
(3) target systolic blood pressure (SBP) resuscitation goals have been redefined for casualties with and without traumatic brain injury (TBI) coexisting with their hemorrhagic shock; and
(4)empiric prehospital calcium administration is now recommended whenever blood product resuscitation is required.
원문은 이렇고 여기서 중요하게 봐야 할것이
"(2) crystalloids and Hextend are no longer recommended as fluid resuscitation options in hemorrhagic shock"
입니다.
관련 내용에 대한 PubMed에 올라온 것
https://pubmed.ncbi.nlm.nih.gov/34969143/
요약-TCCC가이드라인 에서는 더이상 crystalloids와 Hextend가 권장 되지 않는다
+민간에서도 근래에 의사들이 수액을 최소한으로 적게 주고 오는 걸 권장하거나 119 구급대원들에게도 인식이 많이 퍼져나가고 있다 합니다 아마도 PHTLS 교육 영향이 큰듯 합니다
+이 글의 의미는 모든 상황에 TCCC 가이드라인대로 적용하라는 의미가 아닙니다. 결국에 한국의 환경에서는 병원전수혈이 불가능하기에, 뇌혈류를 유지하기 위해서 최소한의, 최후의 수액은 필요합니다
