Here is a great article, that actually rejects cortico-steroids, and yet extolls the use of Hypertonic Saline. It also recommends the Hetastarch you mentioned:

No steroids
"There is no data supporting the use of GC in generalized trauma (i.e. hit by car, dog fights, etc.) or heat stroke. In fact GC may increase morbidity and mortality due to the numerous adverse effects. Supportive care such as crystalloids and colloids, pain management with opioids, and body temperature are the primary recommendations along with stabilization of blood loss and fractures. Antimicrobials may also be indicated."


Advantages of Hypertonic Saline
"Hypertonic saline typically contains either a 5% or 7.2% concentration of sodium chloride. Hypertonic saline is administered relatively quickly, over 5 minutes, and results an increase in plasma osmolality. Advantages of hypertonic saline include the rapid administration of fluid, low volume, low cost, and efficacy. Studies in experimental dogs have indicated hypertonic saline, 4 mL/kg, induces a plasma volume change of 20 mL/kg. Other effects of hypertonic saline include improvements in cardiac output, arterial blood pressure, splachnic blood flow, and acid base status. Hypertonic saline does not appear to cause vasoconstriction or other changes in the mechanical properties of the circulatory system. The primary effects appear to be due to plasma volume expansion.

Administration of 7% hypertonic saline solution (4-5 mL/kg) results in increases in serum osmolality by approximately 28 mOsm/L within 10 minutes. The elevation remains approximately 12 mOsm/L above control values for 4-12 hours. As expected increases in serum sodium and chloride concentrations (~13 mEq/L) occur within 10 minutes of administration. No adverse effects have been noted with these changes in osmolality and sodium concentrations. Serum potassium values decrease following administration in a similar manner to administration of isotonic fluids. Serum potassium concentrations drop by approximate 0.8 mEq/L and no adverse effects have been reported.

Hypertonic saline has been studied in experimental models of hemorrhagic shock, endotoxic shock, and shock due to gastric dilatiation with volvulus. In each case hypertonic saline produced an equal or better effect to traditional resuscitation with isotonic fluids. Resuscitation with isotonic fluids or colloids results in increased intracranial pressure and, worsens cerebral edema. Hypertonic saline does not appear to increase intracranial pressure. Additionally, hypertonic saline does not increase lung water volume during resuscitative administration as compared to isotonic fluid administration. In models of GDV in dogs, hypertonic saline (in combination with dextran-60) 5 mL/kg, resulted in a more effective and sustained resuscitation than did lactated ringers solution, 60 mL/kg. Hypertonic saline treated dogs maintained a better cardiac output for the 3 hour monitoring period and experienced less hemodiltuion. However it is important to remember that experimental models do not always predict naturally occurring conditions.

Hypertonic saline has been assessed in human clinical trials in a variety of conditions resulting in shock. Hypertonic saline (7%) was administered to patients with a variety of conditions resulting in shock which were initially non-responsive to conventional resuscitation. No adverse effects were noted and 9/11 patients which were initially non-responsive, but responded to hypertonic saline. In a controlled study, hypertonic saline in combination with dextran-70 was compared in a blind fashion to isotonic fluid therapy in trauma patients. Patients treated with hypertonic saline had significantly higher mean arterial pressures on arrival to the hospital and a subsequent higher survival rate. Postoperative hypovolemia in surgical patients treated with hypertonic saline maintained increased systemic arterial blood pressures, atrial filling pressures, and cardiac output with less volume administration as compared to isotonic fluids.

Hypertonic saline is not an appropriate choice for resuscitation of a dehydrated animal. Dehydration requires replacement of fluid and electrolyte content of which isotonic solutions are better choices. Hypernatremia is also considered a contraindication to administration of hypertonic saline. Finally, cases of fluid overload (increases in intravascular fluid volume) are also considered a contraindication to hypertonic saline."


Hetastarch
"Hetastarch is a commonly used colloid solution in veterinary medicine due to its ease of use and storage, and its relatively low cost. Hetastarch has a mean molecular weight of 70,000 (albumin is approximately 69,000 MW) with a colloid oncotic pressure of 30 mm Hg (albumin is approximately 18-20 mm Hg). Hetastarch ranges in size from 10,000 MW to 1,000,000 MW with sizes less than 50,000 MW eliminated by the kidneys, whereas large sized molecules are primarily cleared by the liver and spleen. Hetastarch is an effective volume expander with each mL capable of retaining approximately 30 mL of water. This property results in a volume expansion greater than the volume administered and may persist for up to 24 hours. Up to 50% of the administered hetastarch volume is retained in the vasculature for 48 hours. Hetastarch may increase the bleeding tendency due to a dilutional effect of clotting factors (fibrinogen and antithrombin III). A single case report in humans detailed a subclinical von Willebrand's patient that experienced increased bleeding following administration. Overall the adverse effect rate of hetastarch in humans is low, 0.085%.

Colloids are often used for shock resuscitation. Colloids provide rapid volume expansion with a low volume administration, which persists for long time periods. Hetastarch is often administered in conjunction with cystalloids to prolong the volume expansion provided by the crystalloids. A common dosing strategy for resuscitation is to administer 5 mL/kg of hypertonic saline (7.2%) followed by 5 mL/kg of hetastarch. As previously mentioned, colloids can increase intracranial pressure and cerebral edema, therefore should be used cautiously in patients with head trauma. Colloids can also be administered to hypoproteinemic animals to increase oncotic pressure and maintain proper fluid balance. A response to colloid administration is often noted within 12 hours including decreases in peripheral edema, increased urine production, and decreased lung volume. However it is important to note that hetastarch should not be used to treat cardiogenic pulmonary edema as it may worsen the condition due to increased pulmonary arterial pressures."


It remains someone confusing on the steroid issue ... but it seems universal that fluids, and hypertonic Saline, are good for after-battle shock treatment.

Time for bed now ... got a bunch of stuff to do tomorrow ... but this is getting more and more interesting.

Jack