Hypertonic Saline in TBI

[Doczilla]

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

'zilla

[JakeEMTP]

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

[HellsBells]

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

[cprted]

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.

https://roc.uwctc.org/tiki/completed-studies

[paramedicmike]

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

[Kiwiology]

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

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

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.

https://roc.uwctc.or...mpleted-studies

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

[Kiwiology]

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?

Edited February 6, 2012 by kiwimedic

[BEorP]

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.

https://roc.uwctc.or...mpleted-studies

Yeah, they were using 7.5% and published their results in 2010:

http://jama.ama-assn.org/content/304/13/1455.long

[Eydawn]

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

[DFIB]

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