Remember, a liter of Hextend is equivalent to more than six liters of Ringer's
(c) If a casualty's pulse does not return after one liter of Hextend, the
casualty is probably continuing to bleed internally. This casualty needs a rapid
evacuation to a surgical facility for hemorrhage control. If you continue to give large
amounts of fluids to a casualty who continues to bleed, you can speed the loss of the
remaining red blood cells. This dilutes the blood's natural ability to clot and raises the
casualty's blood pressure. Doing so will actually cause the wound to bleed faster.
Consequently, you only want to raise the blood pressure high enough to perfuse all the
vital organs, but not enough to promote more rapid hemorrhage.
a. Care must be taken to protect the casualty from hypothermia (low body
temperature). Casualties who are hypovolemic become hypothermic quite rapidly if
traveling in a casualty evacuation (CASEVAC) or medical evacuation (MEDEVAC)
asset and are not protected from the wind, regardless of the ambient temperature.
Figure 1-3 depicts why casualties can rapidly become hypothermic. When
transporting casualties by rotary-wing aircraft, they must be protected from
the wind coming in the cargo doors when flying with the doors open.
Figure 1-3. Casualties exposed to possible hypothermia.
b. Casualties who become hypothermic develop the vicious triad: