Are victims of injury sometimes victimized by attempts at fluid resuscitation?

See related article, p 155. Intravenous crystalloid is considered universally indicated for patients with post-traumatic hypotension of presumed hemorrhagic origin, regardless of the mechanism of injury, anatomic location, and whether hemostasis has been achieved.I, 2 This premise is based primarily on animal studies conducted by Wiggers, Shire et al, and others. 3-5 In these classical studies it was clearly demonstrated that following a controlled catheter blood withdrawal of sufficient quantity to produce hemorrhagic shock, aggressive volume resuscitation with large quantities of isotonic crystalloid in combination with autologous blood was necessary for survival. There are, however, serious doubts about the clinical relevancy of atraumatically withdrawing blood through a surgically implanted catheter. In the clinical setting, hemorrhage results from an injury to the vascular circuit. Until that injury site is compressed or repaired, the possibility for further hemorrhage exists. Moreover, there are no clinical trials that have shown that administering large volumes of IV crystalloid to hemorrhaging patients is efficacious. Despite the limitations of experimental models that use a controlled hemorrhage methodology and the absence of appropriate clinical trials, early and aggressive fluid resuscitation remains a cornerstone of care for hypotensive injury victims with suspected hemorrhage. Most clinicians conclude that the benefits of early aggressive IV fluid therapy are intuitively obvious and therefore require no further study. It is believed that the advantages of attempting hydrostatic blood pressure elevation far outweigh the potential problems of "under-resuscitation." Hypotensive injury victims often have a good outcome following fluid resuscitation and therefore seem to benefit from this