ATLS Guidelines on Fluid Resuscitation
This section summarises principles for fluid resuscitation in major trauma, placing ATLS teaching in the context of contemporary UK guidance (NICE NG39, NICE NG29, Resuscitation Council UK, RCEM). The emphasis is a restrictive crystalloid strategy, early recognition of patients who need blood components, rapid haemorrhage control and prompt activation of local massive haemorrhage protocols (MHPs).
Physiological aims
- Restore circulating volume sufficiently to maintain vital organ perfusion and oxygen delivery while avoiding interventions that worsen bleeding or coagulopathy.
- Prevent or limit the lethal triad of hypothermia, acidosis and coagulopathy and avoid tissue oedema that impairs haemostasis and organ function.
- Buy time for definitive haemorrhage control (surgery, interventional radiology, local measures) and enable targeted correction of coagulopathy with blood components.
Key principle
Crystalloids transiently expand intravascular volume but do not carry oxygen and dilute clotting factors; blood components restore oxygen-carrying capacity and coagulation substrates and should be used early when significant haemorrhage is suspected (NICE NG39).
Initial assessment and decision priorities
- Rapidly identify likely bleeding source and severity from mechanism, physiology and examination.
- In pre-hospital care, use crystalloids only if blood components are unavailable; titrate to a palpable central pulse (carotid or femoral) rather than a normal blood pressure, and transfer rapidly to definitive care (NICE NG39).
- In-hospital, avoid prolonged large-volume crystalloid resuscitation in patients with ongoing...