Now can we stop using NS?

E tank

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Aside from the claims of increased cost (like a bag of IV fluid will affect the bill of an ambulance ride and a full ER work-up to say nothing of going to the ICU or OR or both...)NS sux...Although this link concerns hyperkalemia in renal failure (I can't understand why people hang iv fluid on renal failure patients in the OR, another day perhaps...)it does go in to the acidosis created by a liter of NS, let alone the 2 or 3 that some critical patients receive before meeting me...Can we stop now?

https://emcrit.org/pulmcrit/myth-busting-lactated-ringers-is-safe-in-hyperkalemia-and-is-superior-to-ns/

This is just NS v. LR...I'd love to see more plasmalyte or normosol, at least on helicopters...to expensive? Please...spare me!
 

NPO

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One service I work at carries NS & LR, and is phasing out NS and adding plasmalyte. I'm not sure if they are keeping LR.

Edit: ground service
 

StCEMT

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I snuck it into a protocol that I wrote to try and create a reason to bring it onto our trucks. I haven't heard anything back and that has been about two months. Unfortunately change is slow.
 

VFlutter

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It infuriates me that we do not carry LR, only NS. I'd even take Hextend/Hespan. But shortly we will have our PRBC and Plasma so I guess I can't gripe too much.
 

E tank

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One service I work at carries NS & LR, and is phasing out NS and adding plasmalyte. I'm not sure if they are keeping LR.

Edit: ground service
A ground service doing this? I'm completely shocked...there is a Santa Claus....
 

E tank

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I snuck it into a protocol that I wrote to try and create a reason to bring it onto our trucks. I haven't heard anything back and that has been about two months. Unfortunately change is slow.
Don't hold your breath...tertiary referral center/hems here....NS is king...Had a ruptured AAA flown in 2 weeks ago. 2 liters of NS in the air after a liter in referring center, no blood for some reason...never got to the bottom of that...Fought the acidosis the whole repair...Walked out of the hospital though, so there's that..
 

StCEMT

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Don't hold your breath...tertiary referral center/hems here....NS is king...Had a ruptured AAA flown in 2 weeks ago. 2 liters of NS in the air after a liter in referring center, no blood for some reason...never got to the bottom of that...Fought the acidosis the whole repair...Walked out of the hospital though, so there's that..
I'm not. While we have gotten some pretty damn good upgrades in equipment, there are still things that make me beat my head in the wall protocol wise. This combined with the annoyingly slow rate of change is one of them.

Seems like it would have been prudent of the sending facility to hang some blood, but...
 

StCEMT

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Now that I have had a chance to read it, I believe that is the same article I used for the prior mentioned protocol. I wrote one for Hyperkalemia since we don't have one and the last legit pt like this I ran technically fell under the symptomatic bradycardia protocol of ours if I go off what is given. I didn't use it, but if I were to have been cookie cutter, exactly by the book....

I used that article because we tend to like dumping fluids when we see not so happy numbers in our BP box....if people are gonna do it, we might as well be using better options.
 

RocketMedic

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We've got plasmalyte
 

E tank

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It infuriates me that we do not carry LR, only NS. I'd even take Hextend/Hespan. But shortly we will have our PRBC and Plasma so I guess I can't gripe too much.
This study:

Anesthesiology. 2014 Oct;121(4):730-9.
Effect of hydroxyethyl starch on postoperative kidney function in patients having noncardiac surgery.
Kashy BK1, Podolyak A, Makarova N, Dalton JE, Sessler DI, Kurz A.

was the death knell for those fluids. It was pretty controversial, but pretty much everyone took Hextend and Hespan off their carts. I used them quite a bit. I hear of a few places where folks still hang one or the other, but those are few and far between. Now when I want a quick, sustained volume expansion, I use the much more expensive 5% albumin.
 

Brandon O

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No starch in the blood please.
 

Bullets

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Are agencies still routinely hanging fluid on patients that arent hypotensive or hypovolemic?
 

Uclabruin103

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No, we don't even start lines of we're not giving anything. And they just took dopamine away from us.... I know, I know, dopamine's efficacy of up for debate, but it was our only pressor.
 

PotatoMedic

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No, we don't even start lines of we're not giving anything. And they just took dopamine away from us.... I know, I know, dopamine's efficacy of up for debate, but it was our only pressor.
They won't let you mix up an epi drip?
 

NPO

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Are agencies still routinely hanging fluid on patients that arent hypotensive or hypovolemic?
Not at my full time agency. We also carry 500ml bags. Not sure why, but I'm okay with it because our volume patients probably don't need volume of NS.
 

bigbaldguy

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We took off Dopamine from commercial aircraft EMKs but now 2 years later it's back. I think it had more to do with the shortage than effectivness.
 

NPO

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From the cabinet of my ambulance. This is only my part time job. My full time service is using NS as I mentioned above, but I've introduced the idea of switching to our clinical dept.
IMG_20181117_130234.jpeg
 

E tank

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Well, it looks like you've got the good stuff just to the left of the NS. If what your using the NS for is just a carrier for medicine and not volume, then I guess there'd be a cost argument. But if volume is the issue, looks like you have all you need right there.
 

NPO

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Well, it looks like you've got the good stuff just to the left of the NS. If what your using the NS for is just a carrier for medicine and not volume, then I guess there'd be a cost argument. But if volume is the issue, looks like you have all you need right there.
We carry the NS for the few instances where LR (which was replaced by PlasmaLyte) wouldn't be as beneficial. I believe the only situations I'm aware of would be a severe alkalosis.

For medications we carry D5W. And D10 for those diabetics who need the sugar.
 
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