[glenyork]

First ask what are you using crystalloid fluids for...today the current philosophy is to only give fluids for bleeding with shock if the casualty has a blood pressure below 80 systolic or unconsciousness from bleeding out. This is because at this B/P he is not perfusing his brain with oxygen. If you give fluids above this B/P then all you will do is blow out blood clots and help the guy to bleed out. Instead of only carrying crystalloids, also carry hetastarch (Hextend ©, or an equivalent volume expander), which is a colloid and will stay in the vascular system longer and it will "expand" the blood volume. One 500cc bag of hetastarch is equal to 3 1000cc bags of crystalloid fluid.

So, back to fluids. There is still a need for crystalloids and that is dehydration and burns. We use a fluid replacement for burns at 2 to 4 ml per kg x percent burn give on half over first 8 hours from time of burn and the second one half over the next 16 hours for a starter and measure urine output.

Back to your question...500 or 1000cc, it does not matter and it is just a preference. Since I am treating burns and dehydration I will carry 1000cc bags as with even a min burn it takes a lot of fluid, example = a 70kg pt with 10% burn x 4ml will equal 2800 cc of fluid and one half will be 1400 given the first 8 hours. I spread the carrying of the fluids over the whole team as one man can not carry the load. Next question is how long will it take to extract.

Good luck, probably more than you wanted to know. If you have any more questions or if I need to clarify any point further please feel free to contact me....

glenyork (docyork) out...

"All bleeding will stop eventually"