Fluids, Blood Substitutes, and New Tools

Fluid management can be one of the most critical decisions in patients with penetrating injuries. Patients with ongoing hemorrhage and/or third space loss often require significant replacement until control of the hemorrhage is obtained. Restoration of normal blood pressure until control of hemorrhage is obtained is controversial. Isotonic fluid is widely accepted as the initial fluid for resuscitation. Blood and blood products follow to replace ongoing losses. The role of colloids and the volume of resuscitation remain controversial. Whole blood may have a role in massive transfusion scenarios. Autotransfusion of processed blood from intraoperative and closed drainage systems is an adjunct when blood supplies are limited.