Okay, here comes my attempt to answer some of this.
1. MedicFL -- Pt had severe blood loss, maybe 1000cc. So we are dealing with hypovolemic shock. Mind you he has an open fx of the occipital portion with brain being exposed. While the hypotension could be related to the neuro deficit (GCS 7, therefore a classic TBI) we can do little in the field to correct that part other than do our best to control bleeding and replace lost fluid. Unfortunately, his initial SP02 was 70 and when you give that much fluid you are replacing a lot of that blood with NSS that cannot carry 02 and C02. We did however hyperventilate and it seemed to aid in controlling the bleeding. But no matter what, you are dammed if you do, dammed if you don't.
2. Pseudoknot -- I was presented with the same research findings as you. It seems really simple to say but in an emergency, no matter how lost you are, remember the ABC and the rest will come to you. Without an airway, you don't got crap. And you are correct with mannitol in the pre-hospital setting (my bread and butter) as we no longer carry it in our service.
3. MedicFL (again 😎) -- We have a neuro injury (decorticate posturing and disconjugate gaze with GCS 7) and we have a hemorrhage caused by traumatic event. We cannot do a whole lot to fix the neuro injury other than drive faster or lifeflight them to a trauma ctr. But we can attempt to control bleeding and replace fluid. ST was rate 120-130. Obviously there is a compensation mechanism in play here. The entire thing was a judgment call, from how much fluid to pump in to attempting intubation. EMS = think now, act now. We, like those in the ER, are forced to make very quick decisions at times and be confident in doing so. Just like your friendly neighborhood MD/DO or PA/NP, we can't always be certain of what the Pt outcome will be.
dxu