Rappahannock Community College
Permissive hypotension should be part of the Trauma Protocol of the Peninsulas Emergency Medical Service (PEMS) Region to prevent further injury to patients with traumatic injuries. Currently the Trauma Protocol states: “Suspected hypovolemia 20 mL/kg 0.9% normal saline up to 1000 mL bolus, continuously reassess need for further fluid” (page 1 of 2, Trauma). There is no guidance in the current PEMS Trauma Protocol to indicate how to determine the “need for further fluid,” which would lead a prehospital medical provider to attempt to achieve a normotensive blood pressure. Current research, however, supports permissive hypotension.
The importance of blood pressure for organ perfusion is well researched and documented. Permissive hypotension is the practice of maintaining systolic blood pressure below the average, or normative blood pressure. Complications from an attempt to establish or maintain normotensive blood pressure in hemorrhagic shock through excessive fluid resuscitation may include increased arterial and venous pressure, dilution of clotting factors, and decreased blood viscosity. Increased arterial and venous pressure can impede hemostasis because the high pressure may cause clots to break loose once they are formed or not be able to form at all.
Craig, Seth, "Recommendation for Permissive Hypotension for Trauma Patients in the Prehospital Setting in Peninsulas Emergency Medical Services Council, Inc." (2016). Student Writing. 10.