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  1. Leah Burgess,
  2. Rob Taylor
  1. Correspondence to Leah Burgess, Accident and Emergency Department, Royal Cornwall Hospital, UK; jonathan.wyatt{at}

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Prehospital hypertonic saline

Following traumatic brain injury, a main aim of treatment is to maintain cerebral perfusion and minimise cerebral oedema. Previous evidence is limited, but suggests that hypertonic fluids may restore cerebral perfusion and decrease intracranial pressure in patients with serious head injury. Several trials have indicated that out-of-hospital administration of hypertonic fluids improves neurological outcome in hypovolaemic shock. A large randomized, double-blinded, placebo-controlled trial from North America revealed that early out-of-hospital resuscitation with hypertonic fluids did not improve rates of six-month survival or neurological outcome in those without hypovolaemic shock (JAMA 2010;304:1455–64).


Tranexamic acid is widely used in surgical patients to reduce bleeding. However, its effectiveness in the trauma patient had not been studied, until now. CRASH-2 is a huge trial involving 40 countries and 20 211 trauma patients with, or at risk of, significant bleeding. Considering one-third of trauma deaths in hospital are due to haemorrhage, the results of this study are long awaited. It randomised patients to receive early administration of tranexamic acid or placebo. All-cause mortality and …

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