IV Fluids used in your system

[medic417]

NS, LR, D5W, Hetastarch

 

[daedalus]

We call it a "Normasaline Bag" in front of patients sometimes. We never expressly say that it's medicine, so we aren't open to liability, but it makes some of the more hypocondriac among our patients to calm down, because saying "Normal Saline" that fast makes them think there is something good coming.

You wouldn't believe how many of them just fall asleep after we start the flow, thinking they are getting something a little more powerful than fluids.

What??

(10char)

 

[PapaBear434]

What??

(10char)

A little trick I picked up from my proctor. If you have someone who thinks they are dying, but are actually by all accounts fine ("I'm having a heart attack!" with a completely normal rhythm but they are just freaking out over indigestion), you hang a bag, start an IV, and let it flow. You at some point say Normal Saline real fast to your partner, pronounced "normasalin" or something similar.

Patient feels gentle cool feeling flowing at the site, and think they are getting something powerful and tasty. You never expressly say that it's medicine, and if they ask you tell them what it really is. But most of the time, the suggestion is enough to get them nice and happy. It's a nice trick to see if they are imagining the pain and/or discomfort or if they are really having some trouble.

Of course you never delay REAL treatment (nitro, asprin where appropriate) to do this. But if nothing is warranted by what you find, and you are going to start an IV anyway, it can't really hurt to try.

That was my round about way of saying "We only have NS on our trucks."

 

[Epi-do]

We currently just have NS. In the past we also carried 250 ml bags of D5W for amio, but no longer carry it. We were told to just administer it in the NS instead. At one time, some of the services in the Indy metro area carried RL, but I don't know off-hand of anyone who still carries it.

 

[Jon]

Most services just carry LR, and pre-mixed Dopamine and Lidocaine drips... One service has a set-up with 250cc D5W and a label that gives them the amount of drug to add to get different drips... like Amiodarone and Epi drips, and the concentrations. Oh... and the label lets them label the bag, too... so that everyone knows what drug/concentration is in the bag.

 

[Sasha]

NS and D5W for mixing meds.

 

[FireMedic254]

We carry NaSL, LR, and D5W. We carry them in 1000mL, 500mL and 250mL bags.

 

[FireMedic254]

Oh and we do have 250mL Dopamine mix. Our Lidocaine or Marcaine isnt in a bag, but is readily available to draw up.

 

[fma08]

To a degree.... have to review to discuss more in detail. I also want to add the debate between RL and NSS on trauma. Listen to PHTLS podcasts and the Doc describes the reason for RL in lieu of just saline. Yes, saline should be instituted with blood tubing for those that will need fluids and to make things easier when administering blood. I do pose this question though; what is the pH of NSS and the by-product of shock is? ... Then ask yourself, if even infusing 500-2000ml of NSS in the very first few minutes of the development of shock beneficial or maybe even harmful?

R/r 911

NS pH is around 5.5 (http://www.rxlist.com/normal-saline-drug.htm). By-product of shock = anaerobic respiration = acid by-products i.e. lowering of the body's pH even more. So infusing acid on top of potentially producing more acid... Well, I'll argue the point that while NS may be acidic, if infusing enough of it in the first few minutes of shock resolves the inadequate tissue perfusion, then one would not have to worry about the problem of anaerobic respiration (in the short run). However, if the fluid bolus is not enough to restore the perfusion, then there will be some complications coming up... And fast.

But that's what bicarb is for right?

To answer the OP, we get to choose from NS, NS and NS

 

[Katie]

LR

*lengthens to 10 characters*

 

[Akulahawk]

Just remember that LR's normal pH is 6.5...

http://www.rxlist.com/lactated-ringers-drug.htm

click on the link for the table pop-up... the info is there.

 

[Melclin]

Here in Aussie land.

Our state service recently switched from Hartmann's to NS for fluid replacement.

I've been told that the following are the reasons behind the change.

-Too little evidence for efficacy.
-Concern over major trauma pts and kidney problems.
-compatibility issues with other drugs.
-To expensive given the lack of efficacy.

Most services use NS as far as I know, some use Hartmann's (obviously along with D5W for medications on those trucks that have them; MICA, IC, MICU etc).

 

[Jon]

Silly question - what exactly is Hartmann's, and why would it be used?

 

[Ridryder911]

Silly question - what exactly is Hartmann's, and why would it be used?

It is almost exactly alike Ringers Lactate but the ionic is slightly different. Many Trauma Doc's like the solution...

R/r 911

 

[SES4]

The gold standard: Normal Saline and Ringers Lactate.

 

[fma08]

It is almost exactly alike Ringers Lactate but the ionic is slightly different. Many Trauma Doc's like the solution...

R/r 911

Was my answer even close to what you were looking for in the question about NS in shock?

 

[Ridryder911]

NS pH is around 5.5 (http://www.rxlist.com/normal-saline-drug.htm). By-product of shock = anaerobic respiration = acid by-products i.e. lowering of the body's pH even more. So infusing acid on top of potentially producing more acid... Well, I'll argue the point that while NS may be acidic, if infusing enough of it in the first few minutes of shock resolves the inadequate tissue perfusion, then one would not have to worry about the problem of anaerobic respiration (in the short run). However, if the fluid bolus is not enough to restore the perfusion, then there will be some complications coming up... And fast.

But that's what bicarb is for right?

To answer the OP, we get to choose from NS, NS and NS

Very good. Yes, the question or debate is should we "flooding" more fluid that is acidotic in lactic acidosis situation? Especially, in the early critical period of development of shock....Something to consider.. yes, it may matter.

R/r 911

 

[Tal]

MDA works with normal saline 0.9% and D5W (and there are 10cc amp. of WFI)

the IDF works with normal saline\ Ringer's Lactate (which is better in case of truama i guess)

 

[Jon]

MDA works with normal saline 0.9% and D5W (and there are 10cc amp. of WFI)

the IDF works with normal saline\ Ringer's Lactate (which is better in case of truama i guess)

What's WFI?

 

[Tal]

What's WFI?

water for injection