Assignment Task: You are a medical student on call in the neuro ICU on a rainy Friday night. You receive an emergency page that a critical patient is being flown to your facility after a motor vehicle accident. He is an otherwise healthy 27 year old male who was the unrestrained driver in a high speed collision vs a telephone pole. He was unconscious when the paramedics arrived on the scene. He is not bleeding anywhere. Upon arrival to the trauma center, a CT scan of the head showed a severe brain injury. Your attending explains that because of this injury, the cells inside his brain have taken on extra water and are very swollen. This swelling has caused increased pressure inside his skull. You know this is a very morbid finding. If emergent measures are not taken, he will progress to brain death within hours. His newlywed wife arrives and begs you to save her husband. She's pregnant and hasn't told him yet. You then remember learning about osmosis from your excellent general biology professor and wonder how application of this fundamental concept could help you take care of your patient. You remember that she said water always follows sodium across the cell membrane. Your attending reminds you that the average sodium concentration in the blood is 0.9%, meaning that 0.9% is isotonic to the cells. The nurse has just started an IV and asks what fluid you would like to run.
What intravenous fluid would be best to help relieve the cellular swelling and increased intracranial pressure? Defend your answer.
a) sterile water
b) 0.45% sodium chloride
c) 0.9% sodium chloride
d) 3% sodium chloride
e) whole blood