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Now can we stop using NS?

Discussion in 'ALS Discussion' started by E tank, Sep 8, 2018.

  1. E tank

    E tank Caution: Paralyzing Agent

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    Thats a lot of NS for that reason...
     
  2. NPO

    NPO Forum Deputy Chief

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    I'm not saying you're wrong. I'll follow up with the clinical ed guy and see what he says specifically
     
  3. Tigger

    Tigger Dodges Pucks Community Leader

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    Is plasmalyte compatible with for most/all med administration? Anyone have any idea what the unit cost is?

    I don't give large boluses to bleeding patients, I take them to blood (helicopter, local ED, etc). Sometimes septic and anaphylactic patients get large boluses of NS but I don't think that's necessarily proven to be bad? Is the cost worth it to have other solutions for the rare bleeding patient in need of blood yet you can't get to it? I don't know.
     
  4. NPO

    NPO Forum Deputy Chief

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    I recently priced unit costs at retail price from Boundtree, our medical supplier. These approximate costs do not reflect our bulk purchasing agreement discount...

    Normal saline: $9/1L bag
    LR: $11/1L Bag
    PlasmaLyte: $25/1L Bag
     
  5. E tank

    E tank Caution: Paralyzing Agent

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    There is enough controversy to cause a fair amount of investigation in comparing NS to stuff like plasmalyte et al...I think one thing that isn't controversial is that kidneys don't like a lot of chloride ion. At the end of the day, if you're not giving a lot of fluid (>2L?) it doesn't matter. But in situations of a real acidosis, that require volume, a solution with a pH of 7.4 is better than one with a pH of 5. Managing the acidosis is a lot easier, at least in the short term.
     
  6. NPO

    NPO Forum Deputy Chief

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    I asked a few people why they would use the NS and not the PlasmaLyte, each said "TKO"
     
    E tank likes this.
  7. E tank

    E tank Caution: Paralyzing Agent

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    A saline lock is cheaper...
     
  8. Peak

    Peak ED/Prehospital Registered Nurse

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    The Vanderbilt study showed more long term kidney dysfunction with NS over LR in adult sepsis patients. They are also prone to organ dysfunction as part of their disease process so I don't know if the same would apply to anaphylaxis.
     
  9. E tank

    E tank Caution: Paralyzing Agent

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    A lot of NS isn't a good choice if you have something else available. If it isn't good for burns, it isn't good for anyone else that needs a lot.
     
  10. NPO

    NPO Forum Deputy Chief

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    We use locks
     
  11. Akulahawk

    Akulahawk EMT-P/ED RN Community Leader

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    Where I work, we primarily use NS for our initial resus. What I personally would like to see is us switch fluids from NS to something else like LR or Plasmalyte after the first 2 liters. What I'd also like to see is actually reducing the amount of fluids administered in total. That's not likely to happen any time soon though. They're not too concerned with dumping in 3-4 (or more) liters of NS in a patient that's hypotensive. I suspect they figure if the patient survives, they can just diurese the patient later... and let the ICU deal with that problem.

    What do I know, I'm just an RN/Medic...
     
    PotatoMedic likes this.
  12. aquabear

    aquabear World's Okayest Paramedic

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    What county in California did that?
     
  13. DesertMedic66

    DesertMedic66 Forum Troll

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    In Riverside County we took out Dopamine well over 8 years ago. In the past 3 years we have also only been starting IVs on patients that: we give fluids, we give medications, have a high potential of crashing. We no longer start curiosity IVs. Even if we know this patient will get an IV at the ED we do not start it.

    ICEMA recently took Dopamine off of their standard equipment list.
     

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