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ATLS: initial fluid management

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Two large cannulae - brown venflons, should be inserted into the anterior cubital fossae of each arm. If venous access is difficult, e.g. due to peripheral vasoconstriction, other sites must be considered. A central venous line is not used due to the risk of pneumothorax.

On gaining venous access samples of blood may be taken for crossmatch. An example fluid regimen is shown elsewhere, but essentially, fluid should be run in as fast as possible; it being better to give too much rather than too little, and the patient's response monitored. If the patient remains shocked, group specific or O Negative blood should be given as cross-matching may take up to 45 minutes. If the patient still fails to improve, internal bleeding should be sought.

Following stabilisation, fluid infusion may be moderated according to urine production.

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