Please select the eligibility criteria that correspond to the clinical trial below.
Title: Phase 3 Study of Hypertonic Resuscitation Following Traumatic Injury With Hypovolemic Shock
Brief Summary: The purpose of this study is to determine if hypertonic saline with and without dextran can improve overall survival in victims of trauma with shock.

Injury and lost blood from trauma can cause your body to be in shock (low blood pressure related to blood loss). This decreased blood flow can lead to organ damage. In order to restore the blood pressure and blood flow, the medics give fluids into the patients' veins as soon as possible. This is called "resuscitation." The resuscitation fluid most commonly used is "isotonic" or one that is the same concentration as the blood. The investigators are trying to determine if infusing a "hypertonic" fluid (or one more concentrated than the blood) can increase the blood pressure and restore blood flow more efficiently. The hypertonic fluids the investigators are using are called hypertonic saline with dextran (HSD) and hypertonic saline (no dextran). Hypertonic saline is a salt solution that is slightly more concentrated than your blood. Dextran is a sugar solution.


Options:
A: Inclusion Criteria:

* Blunt trauma
* Pre-hospital Glasgow Coma Scale equal to or less than 8(GCS≤8)\*
* Age 15 years or older or 50 kg or more

  * Patients who met the inclusion criteria above and did not meet the exclusion criteria below but who had systolic blood pressure (SBP) ≤70 or SBP\>70 and SBP≤90 and heart rate (HR)≥108 were included in the Hypertonic Resuscitation following Traumatic Injury study that focused on shock patients who may or may not have a traumatic brain injury (TBI). In other words, patients with both TBI and shock would not be included in this study of TBI patients without shock at the time of enrollment.

Exclusion Criteria:

* Known or suspected pregnancy
* Age younger than 15 years or less than 50 kg if age unknown
* Ongoing pre-hospital cardiopulmonary resuscitation (CPR)
* Administration of more than 2L crystalloid or any colloid or blood products
* Severe hypothermia (T less than 28C)
* Drowning or asphyxia due to hanging
* Burns TBSA more than 20%
* Isolated penetrating injury to the head
* Inability to obtain pre-hospital intravenous access
* Time of call received at dispatch to study intervention more than four hours
* Known prisoners
B: Inclusion Criteria:

* Blunt or penetrating trauma
* Prehospital Systolic Blood Pressure (SBP) \<= 70;OR
* Prehospital SBP 71-90 AND Hear Rate (HR) ≥108
* 15 years of age or older, or 50kg or more if age unknown

Exclusion Criteria:

* Known or suspected pregnancy
* Age younger than 15 or less than 50kg if age unknown
* Ongoing prehospital cardiopulmonary resuscitation (CPR)
* Administration of more than 2000cc crystalloid or any colloid or blood products
* Severe hypothermia (suspected Temperature less than 28 degrees celsius)
* Drowning or asphyxia due to hanging
* Burns Total Body Surface Area (TBSA) more than 20%
* Isolated penetrating injury to the head
* Inability to obtain prehospital intravenous access
* Time of call received at dispatch to study intervention greater than four hours
* Known prisoners
C: Inclusion Criteria:

All adult patients who

* Undergo resuscitation in the ICU
* AND fulfillment within the previous 24 hours of the criteria for severe sepsis (SCCM/ACCP)
* AND consent is obtainable either from the patient or by proxy (physician and/or next of kin)

Exclusion Criteria:

The following patients will not be evaluated for inclusion:

* Age \< 18 years old
* Previously randomised in the 6S trial
* Allergy towards hydroxyethyl starch or malic acid
* Treatment with \> 1000 ml's of any synthetic colloid within the last 24 hours prior to randomisation
* Any form of renal replacement therapy
* Acute burn injury \> 10% body surface area
* Severe hyperkalaemia, p-K \> 6 mM
* Liver or kidney transplantation during current hospital admission
* Intracranial bleeding within current hospitalisation
* Enrollment into another ICU trial of drugs with potential action on circulation, renal function or coagulation
* Withdrawal of active therapy
D: Inclusion Criteria:

* Patients with severe sepsis or septic shock, if each one of the following criteria is satisfied:

  * Proved or suspected infection in at least one site:

    * lung
    * abdomen
    * genito-urinary tract
    * other (blood, skin and soft tissue, central nervous system, bones and joints, cardiac system, catheter-related infection, other)
  * Two or more of the following:

    * a core temperature ≥ 38° C o ≤ 36° C
    * a heart rate ≥ 90 beats/min
    * a respiratory rate ≥ 20 breaths/min or PaCO2 ≤ 32 mmHg or use of mechanical ventilation for an acute process
    * a white blood cell count ≥ 12000/ml or ≤ 4000/ml or immature neutrophils \> 10%
  * Presence of at least a severe organ dysfunction, as measured by the modified Sequential Organ Failure Assessment (SOFA) score:

    * respiratory score \> 1
    * hematologic score \> 1
    * hepatic score \> 1
    * cardiovascular score equal to 1, 3 or 4
    * renal score \> 1

Exclusion Criteria:

* Age below 18 years
* Terminal state
* Known adverse reaction to albumin administration
* Severe sepsis or septic shock in patients after proved or suspected head injury, clinically active
* Congestive heart failure (NYHA score III and IV)
* Pathological conditions in which albumin administration is clinically indicated (hepatic cirrhosis with ascites, intestinal malabsorption syndrome, nephritic syndrome, burns)
* More than 24 hours since inclusion criteria were met
* Religious objection to the administration of human blood products
* Inclusion in other experimental study

Answer: B