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Fluid Resuscitation and IV Considerations in the Pre-Hospital Venue

Fluid Resuscitation and IV Considerations in the Pre-Hospital Venue. Paul A. Werfel, NREMT-P Director, Paramedic Program Clinical Assistant Professor of Health Science SUNY Stony Brook. What is shock?. What causes shock?. Fluid or Blood?. Emergency War Surgery, NATO Handbook: part II.

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Fluid Resuscitation and IV Considerations in the Pre-Hospital Venue

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  1. Fluid Resuscitation and IV Considerations in the Pre-Hospital Venue Paul A. Werfel, NREMT-P Director, Paramedic Program Clinical Assistant Professor of Health Science SUNY Stony Brook

  2. What is shock?

  3. What causes shock?

  4. Fluid or Blood? Emergency War Surgery, NATO Handbook: part II

  5. PURPOSE: • Two major indications for IV fluids: • Replace fluids • Route for administration of medications

  6. Colloids: High molecular weight Proteins that do not diffuse across the CM Colloid osmotic pressure Volume expanders $$$$ and short shelf life Crystalloids: Water and electrolytes The electrolytes will readily diffuse across from the vascular space into the tissues Used is pre-hospital environment CLASSES OF IV FLUIDS:

  7. Other Methods of Classification

  8. ISOTONIC FLUIDS • Electrolyte composition is similar to plasma • When administered to normally hydrated patient, there is no appreciable fluid or electrolyte shift

  9. HYPERTONIC FLUIDS • Higher solute level than plasma • Cause fluid to shift from IC to EC space

  10. COMMON SOLUTIONS

  11. Class: Isotonic crystalloid Description: One of the most frequently used IV fluids in hypovolemic shock. Contains: Sodium (Na+) 130 mEq/L Potassium (K +) 4 mEq/L Calcium (Ca2+) 3 mEq/L Chloride (Cl-) 109 mEq/L Lactate (Lactic acid) 28 mEq/L LACTATED RINGER’S SOLUTION / HARTMANN’S SOLUTION

  12. LACTATED RINGER’S SOLUTION / HARTMANN’S SOLUTION • Indications: • Hypovolemia/KVO • Contraindications: • CHF, renal failure • Administration: • Crystalloids diffuse out of the vascular space in <1hr. 3:1 ratio

  13. Class: Isotonic crystalloid solution Description: Concentration of sodium is near that of blood Contains: Sodium (Na+) 154 mEq/L Chloride (Cl-) 154 mEq/L 0.9 PERCENT SODIUM CHLORIDE / NORMAL SALINE

  14. 0.9 PERCENT SODIUM CHLORIDE / NORMAL SALINE • Indications: • Heat problems • Freshwater drowning • Hypovolemia • DKA • KVO

  15. 5% Dextrose in .9% Sodium Chloride (D5NS) • Class: • Hypertonic crystalloid • Indications: • Heat disorders, freshwater drowning, hypovolemia, peritonitis • Cautions: • May cause venous irritation

  16. 5% Dextrose in Lactated Ringer’s Solution (D5LR) • Class: • Hypertonic crystalloid • Indications: • Hypovolemia • Hemorrhagic shock • Some cases of acidosis

  17. Types of IV Access • Peripheral venous access • Central venous access

  18. Peripheral IV Access Sites

  19. Packaging of IV Fluids • Most packaged in soft plastic or vinyl bags. • Container provides important information: • Label lists fluid type and expiration date. • Medication administration port. • Administration set port.

  20. IV Solution Containers

  21. Do not use any IV fluids after their expiration date; any fluids that appear cloudy, discolored, or laced with particulate; or any fluid whose sealed packaging has been opened or tampered with.

  22. IV Administration Sets • Macrodrip—10 gtts = 1 ml, for giving large amounts of fluid. • Microdrip—60 gtts = 1 ml, for restricting amounts of fluid. • Blood tubing—has a filter to prevent clots from blood products from entering the body. • Measured volume—delivers specific volumes of fluids.

  23. IV Administration Sets (continued) • IV extension tubing—extends original tubing. • Electromechanical pump tubing—specific for each pump. • Miscellaneous—some sets have a dial that can set the flow rates.

  24. Macrodrip and Microdrip Administration Sets

  25. Secondary IV Administration Set

  26. Measured Volume Administration Set

  27. Intravenous Cannulas • Over-the-needle catheter • Hollow-needle catheter • Plastic catheter inserted through a hollow needle

  28. Over-the-Needle Catheter

  29. Hollow-Needle Catheter

  30. Catheter Inserted Through the Needle

  31. Peripheral IV Access

  32. Place the constricting band

  33. Cleanse the venipuncture site

  34. Insert the intravenous cannula into the vein.

  35. Withdraw any blood samples needed.

  36. Connect the IV tubing.

  37. Secure the site.

  38. Label the IV solution bag.

  39. Pain Local infection Pyrogenic reaction Catheter shear Inadvertent arterial puncture Circulatory overload Thrombophlebitis Thrombus formation Air embolism Necrosis Anticoagulants IV Access Complications

  40. QUESTIONS?

  41. THANK YOU!

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