Synopsis
Choose fluid or blood components for the physiological deficit, organise haemorrhage control promptly, and recognise when continued infusion adds harm without improving perfusion.
- Identify whether the immediate need is resuscitation, replacement of ongoing losses or routine maintenance.
- Use general crystalloid boluses of 500 mL over less than fifteen minutes only when appropriate to the cause.
- Use the separate NICE sepsis starting regimen of 250 mL with reassessment after each bolus.
Investigation priorities
Enable rapid compatible product selection and continuing transfusion.
Management branches
Clinical assessment identifies hypovolaemia without active haemorrhage and without substantial pulmonary or venous congestion.
- Choose an isotonic crystalloid containing sodium 130–154 mmol/L; for general adult resuscitation give 500 mL over less than fifteen minutes when clinically appropriate.
- Use a smaller, cause-specific volume when required, including the 250 mL initial sepsis bolus, and assess frailty, cardiac failure and renal impairment before further doses.
Key medicines
Tranexamic acid for significant traumatic haemorrhageGive 1 g IV over 10 minutes as early as possible within 3 hours of injury, followed by 1 g IV infused over 8 hours using the established trauma regimen.Check prior prehospital dosing and avoid duplicate loading. Do not start beyond three hours after injury unless hyperfibrinolysis is demonstrated; this is not a universal regimen for every bleeding cause.