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Hypertonic Saline in TBI


18 posts in this topic

Posted · Report post

Anyone have prehospital protocols for using hypertonic saline (3% NaCl) for traumatic brain injury?

'zilla

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Posted · Report post

This is all we have for Head Trauma. I don't know if this is what you're looking for, but this is our protocol.

http://www.ncems.org/pdf/Pro54-AdultHeadTrauma.pdf

This is the Multiple Trauma protocol that is referenced.

http://www.ncems.org/pdf/Pro57-MultipleTrauma.pdf

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Posted · Report post

The only fluid we have is NaCl 0.9% and D5W to mix for amiodarone drips.

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Posted · Report post

According the Resuscitation Outcomes Consortium's "Completed Study" page, they ran a study in 2009 that was discontinued when there no improvement found when the hypertonic solution was used.

[url]https://roc.uwctc.org/tiki/completed-studies[/url]

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Posted · Report post

Not for me or anywhere locally of which I'm aware.

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Posted · Report post

[quote name='HellsBells' timestamp='1328380441' post='274628']
The only fluid we have is NaCl 0.9% and D5W to mix for amiodarone drips.
[/quote]

This. We have 10% glucose as well and also use D5 for mixing ketamine

[quote name='cprted' timestamp='1328386093' post='274629']
According the Resuscitation Outcomes Consortium's "Completed Study" page, they ran a study in 2009 that was discontinued when there no improvement found when the hypertonic solution was used.

[url="https://roc.uwctc.org/tiki/completed-studies"]https://roc.uwctc.or...mpleted-studies[/url]
[/quote]

This as last I heard of any study about hypertonic saline was a trial in San Diego County in 2009.

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Posted (edited) · Report post

Now that I think a bit more it interests me greatly that mannitol has been used for years in head trauma (since at least the early 1970s that I personally know of) but hypertonic saline has been shown to have no effect ... aren't they basically the same thing i.e. an osmotic diuretic?

And aren't drugs ending in "ol" a beta blocker? Shouldn't it be manapril? No wait that'd make it an ACE inhibitor, hmm manamide?

And are you my mommy? :D Edited by kiwimedic
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Posted · Report post

[quote name='cprted' timestamp='1328386093' post='274629']
According the Resuscitation Outcomes Consortium's "Completed Study" page, they ran a study in 2009 that was discontinued when there no improvement found when the hypertonic solution was used.

[url="https://roc.uwctc.org/tiki/completed-studies"]https://roc.uwctc.or...mpleted-studies[/url]
[/quote]

Yeah, they were using 7.5% and published their results in 2010:
http://jama.ama-assn.org/content/304/13/1455.long

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Posted · Report post

Mannitol is more easily able to cross the BBB to my understanding, it's a CSF specific diuretic. It's also not easily used prehospitally as you need to have ICP monitoring in place (again, to my understanding) to safely use it... wouldn't we have the same concerns with hypertonic NS if it were also effective in this manner?

Wendy
CO EMT-B
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Posted · Report post

Mannitol is a huge molecule. I am not sure how much pressure it would create as compared to NaCl 3%.

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