Looks like we're in the great NS shortage of winter 07/08. over the last few weeks our saline supply has dwindled down to nothing. all we have now is 1000cc bags of LR and what NS we have in trauma and ped bags. I recall in medic class we talked about situations when you might want to use LR, but not really when specifically not to use it. i know several medics (including myself) have started using locks when fluids aren't needed (since we suddenly have plenty of saline flushes, go figure). any thoughts on situations when not to use LR, besides when giving blood products that is, i think we all know that one.
fluids
- Thread starter nsom9ac
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The only thing we carry is NS, we got rid of LR and D5W years ago.
Ridryder911
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Personally, I prefer RL (Hartmans Solution) for one line and NSS on the other (for blood administration) for trauma. In actuality, since the amount we administer is trivial < 2 liters (hence the reason most have abandoned multiple fluids) it does not matter. Even D5w is not to make much change on a TKO/KVO rate (<25 ml/hr).
I still believe Paramedics should understand fluid and osmolality ranges to understand the need and physiology of fluid shifts.
Personally, I hardly ever "hang" fluids on medical calls. Most cardiac calls rarely need fluids, and locks are much more easier to maintain than moving tubing and a bag of fluids around. This is something I pushed when I re-entered the field, and now our fluid stock has been reduced in half or more.
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I still believe Paramedics should understand fluid and osmolality ranges to understand the need and physiology of fluid shifts.
Personally, I hardly ever "hang" fluids on medical calls. Most cardiac calls rarely need fluids, and locks are much more easier to maintain than moving tubing and a bag of fluids around. This is something I pushed when I re-entered the field, and now our fluid stock has been reduced in half or more.
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MSDeltaFlt
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True. Medicals usually don't need fluids. Significant traumas do. PHTLS teaches that the fluid of choice for trauma is LR, if you need to give blood, NS.
Medic38572
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Brings backup the way we were taught, Medical was taught 60 gtt tubing for every thing except for Abdominal pain and significant Chest pains and Respitory distress's and Hypoglycemia. I remember the day's we carried 1000 ml bags of D5W and eveyone got that unless it was trauma. Now D5W is used for mixing Lidocaine and dopamine drips. The problems with starting hep- locks is we as Paramedics and Emt's dont do billing and it doesnt pay when we do. Most medicare and medicaid programs will pay for IV's but not for heplocks. Go figure. As far as a shortage in NS we havent had a problem getting any at all.
ResTech
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Like Rid said... the amount of fluid that gets administered prehospital it doesnt really matter between LR and NSS. LR is more suitable for dealing with acidosis then NSS when administered in large amounts.
Since we've had the shortage of ns and taking advice from Rid i've began starting locks on almost all my patients. I like that better (of course when it's appropriate) it's one less thing I have to worry about when transferring the patient. Also i use a needleless j loop like what the area hospitals use and the RN's seem to really like that.
SwissEMT
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What the..? A shortage of NS? Where the hell are you guys working? Kenya?
no i hear they actually have ns in kenya 
I heard our manager from the new company complaining about how much of all our supplies are being used. I don't remember the numbers but in the last month there's been an astronomical amount of ns used, as well as various other supplies. So they've removed our access to all supplies and now we have to ask a supervisor for everything all the way down to o2 supplies and electrodes. i think this is kinda petty but hopefully it'll take care of the problem.
I heard our manager from the new company complaining about how much of all our supplies are being used. I don't remember the numbers but in the last month there's been an astronomical amount of ns used, as well as various other supplies. So they've removed our access to all supplies and now we have to ask a supervisor for everything all the way down to o2 supplies and electrodes. i think this is kinda petty but hopefully it'll take care of the problem.
Ridryder911
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Must be a specific area that has a shortage, suppliers apparently have plenty. We have (nor the hospitals) have had difficulty.
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We have both LR and NS. I think it would just be easier to all NS but it's a big truck. Probably 70% of our IV's are saline locks for many of the above reasons. I do not know why you cant bill for them. Maybe it being a hep lock instead of just saline? we bill them as IV's (because they are 'intravascular' lines). When we do hang fluid it is almost always a heated bag.