Fluid Resuscitation
Surviving Sepsis Guidelines 2021: Recommendations and Best Practice Statements
- The recommendation for an initial fluid bolus of 30 mL/kg was downgraded from a strong recommendation to a weak recommendation, based on the low quality of evidence. However, resuscitation should start immediately.
- Balanced crystalloid solution (e.g., lactated Ringer’s solution) should be used (rather than normal saline) for resuscitation.
- Administration of vasopressors should be initiated via peripheral access, as opposed to waiting for placement of central venous access.
- Patients with ongoing vasopressor requirements should receive intravenous corticosteroids (this recommendation was strengthened); however, administration of intravenous vitamin C is explicitly not recommended.
Management of Crush Injury/Syndrome

Crush syndrome is a life and limb-threatening condition that can occur as a result of entrapment of the extremities accompanied by extensive damage of a large muscle mass. It can develop following as little as 1 hour of entrapment. Effective medical care is required to reduce the risk of kidney damage, cardiac arrhythmia, and death. Management includes;
- Fluids: IV fluid to provide 1L/h for 24 to 48 hours (depending on evacuation availability)
- Equipment: ECG, laboratory tests for serum potassium and urine myoglobin, Foley catheter with graduated collection system, tourniquets
- Medications: hyperkalemia
- Manage Pain
- Give Antibiotics
- Continuous monitor with portable monitor; 15-minute to hourly vital signs, examination, urine output documented on flow sheet
Intraosseous Access 101
- IO access provides rapid vascular access in a variety of emergency situations.
- There are several types of IO devices that can be used.
- The humeral site is generally the least painful and quickest to access
- All resuscitation and anaesthetic drugs can be given via the IO route.
- Fluids need to be administered under pressure.
- All devices need to be monitored and a clear handover given.
Burns Resuscitation
- Signs of impending airway compromise include: stridor, wheezing, subjective dyspnea, and a hoarse voice.
- Carbon monoxide (CO) poisoning may manifest with persistent neurologic symptoms or even as cardiac arrest.
- Burns <15% TBSA generaly require only PO fluid resuscitation.
- Do not include first degree burns in the calculation of % TBSA.
- Generally crystalloid solutions should be infused during the initial 18-24 hrs of resuscitation. It is recommended that 5% dextrose be added to maintenance fluids for pediatric patients weighing < 20kg.
- All resuscitation measures should be guided by perfusion pressure and urine output: Target a MAP of 60 mmHg, and urine output of 0.5-1.0ml/kg/hr for adults and 1-1.5mL/kg/h for pediatric patients.