ATLS now includes balanced concept of limited resuscitation and damage control resuscitation. It states that excessive early crystalloid may dilute blood, dislodge clot and increase hemorrhage but too little resuscitation fluid in hypotensive bleeding patients will result in exsanguination following penetrating torso injury.
It states either crystalloid (Lactated Ringers vs. Normal Saline) is acceptable as initial resuscitation for shock. It also states that hypertonic saline is at least equivalent and maybe superior in patients with traumatic brain injury.
