Drugs - Normal Saline 2008-2009

Front 1

Normal Saline Class

Back 1

Electrolyte / Isotonic Crystalloid

Front 2

Normal Saline Action

Back 2

- Electrolyte solution which equivalent osmotically to blood.
- Increases the circulating volume in the vascular system. (2/3 of infused volume leaves vascular space within 1 hour.)

Front 3

Normal Saline Indications

Back 3

- Definitive therapy, or anticipated

- Shock Hypovolemia
- Suspected intra-abdominal catastrophe or ? aortic aneurysm
- Shock (normovolemic: anaphylactic, neurogenic)
- Anaphylaxis

- Shock ? cardiac origin/septic shock
- Dysrhythmias

- Crush injury with extended entrapment > or equal to 2 hours of extremity or torso

- Burns patients with > or equal to 20% 2nd degree or > or equal to 5% 3rd degree

- Respiratory distress with croup-like cough

- Symptomatic ? stimulant intoxication with sudden hypoventilation, oxygen desaturation or apnea

Front 4

Normal Saline Dosage/Route - Definitive therapy, or anticipated - ADULT & PEDS

Back 4

IV SO; adjust prn

Front 5

Normal Saline Dosage/Route - Shock Hypovolemia / Suspected intra-abdominal catastrophe or ? aortic aneurysm / Shock (normovolemic: anaphylactic, neurogenic) / Anaphylaxis - ADULT

Back 5

IV 500 ml bolus.
MR to maintain BP 90 systolic

Front 6

Normal Saline Dosage/Route - Shock Hypovolemia / Suspected intra-abdominal catastrophe or ? aortic aneurysm / Shock (normovolemic: anaphylactic, neurogenic) / Anaphylaxis - PEDS "non cardiogenic"

Back 6

IV/IO PDC;
MR to maintain BP > or equal to [70 + (2 x age)]

Front 7

Normal Saline Dosage/Route - Shock ? cardiac origin/septic shock / Dysrhythmias - ADULT

Back 7

IV Bolus to max 250 ml with clear lungs
MR to maintain BP 90 systolic

Front 8

Normal Saline Dosage/Route - Shock ? cardiac origin/septic shock / Dysrhythmias - PEDS "cardiogenic"

Back 8

IV/IO PDC with clear lungs
MR to x1 to maintain BP > or equal to [70 + (2 x age)]

Front 9

Normal Saline Dosage/Route - Crush injury with extended entrapment > or equal to 2 hours of extremity or torso - ADULT

Back 9

500 ml fluid bolus just prior to extremity release

Front 10

Normal Saline Dosage/Route - Crush injury with extended entrapment > or equal to 2 hours of extremity or torso - PEDS

Back 10

IV PDC just prior to extremity release BHO

Front 11

Normal Saline Dosage/Route - Burns patients with > or equal to 20% 2nd degree or > or equal to 5% 3rd degree - ADULT

Back 11

> or equal to 15 yo = 500 ml fluid bolus, then TKO

Front 12

Normal Saline Dosage/Route - Burns patients with > or equal to 20% 2nd degree or > or equal to 5% 3rd degree - PEDS

Back 12

5-14 yo = 250 ml fluid bolus, then TKO
< 50 yo = 150 ml fluid bolus, then TKO

Front 13

Normal Saline Dosage/Route - Respiratory distress with croup-like cough - ADULT & PEDS

Back 13

5 ml via nebulizer

Front 14

Normal Saline Dosage/Route - Symptomatic ? stimulant intoxication with sudden hypoventilation, oxygen desaturation or apnea - ADULT

Back 14

IV 500 ml bolus MR BHO

Front 15

Normal Saline Contraindications

Back 15

Rales for fluid bolus

Front 16

Normal Saline Side Effects

Back 16

None

Front 17

Normal Saline Concentration

Back 17

1000ml / 10gtts/ml or 250ml / 60gtts/ml

Front 18

Normal Saline Special Information

Back 18

- Content of the 0.9% solution:
= 154 MEQ NA/LITER
= 154 MEQ CL/LITER
- Be conservative in use of fluids with a suspected head injury patient to minimize the risk of developing cerebral edema. Judicious fluid use may be needed for hypotension associated with head injury to maintain cerebral perfusion. [ CPP = MAP - ICP ]
- Check BP and lung sounds to determine if fluid overload may be developing.
- Burn dose is age related so actual amounts are listed.
- Small bag (250 ml) is always used for patients with rales.
- Flow rates
= 18 Ga catheter delivers 80ml/min wide open (maxi tubing)
= 14 Ga catheter delivers 160ml/min wide open (maxi tubing)
- TKO is approximately:
= 5 gtts/min with maxi drip (10 gtt tubing)
= 30 gtts/min with mini drip tubing (60 gtt tubing)