# Fluid Resuscitation

1. The resuscitation fluids of choice for casualties in hemorrhagic shock, listed from most to least preferred, are:

- Whole blood*
- Plasma, red blood cells (RBCs) and platelets in a 1:1:1 ratio*
- Plasma and RBCs in a 1:1 ratio
- Plasma or RBCs alone
- Hextend
- Crystalloid (Lactated Ringers or Plasma-Lyte A)

2. Assess for hemorrhagic shock (altered mental status in the absence of brain injury and/or weak or absent radial pulse).

NOTE: Hypothermia prevention measures (See Hypothermia Pocket Guide) should be initiated while fluid resuscitation is being accomplished.

If not in shock:

- No IV fluids are immediately necessary.
- Fluids by mouth are permissible if the casualty is conscious and can swallow.

If in shock and blood products are available under an approved command or theater blood product administration protocol:

- Resuscitate with whole blood*, or, if not available;
- Plasma, RBCs and platelets in a 1:1:1 ratio*, or, if not available;
- Plasma and RBCs in 1:1 ratio, or, if not available;
- Reconstituted dried plasma, liquid plasma or thawed plasma alone or RBCs alone;
- Reassess the casualty after each unit. Continue resuscitation until a palpable radial pulse, improved mental status or systolic BP of 80-90 is present

If in shock and blood products are not available under an approved command or theater blood product administration protocol due to tactical or logistical constraints:

- Resuscitate with Hextend, or if not available;
- Lactated Ringers or Plasma-Lyte A;
- Reassess the casualty after each 500 mL IV bolus;
- Continue resuscitation until a palpable radial pulse, improved mental status, or systolic BP of 80-90 mmHg is present.
- Discontinue fluid administration when one or more of the above end points has been achieved.