IV Fluid Resuscitation/Drip rates

[ALSfirefighter]

I was just curious as to others protocols for IV fluid resuscitation for non-traumatic reasons. For example, hypotension from dehydration. Here our protocols says give a 200cc fluid challenge, and if SBP remains under 100mmHg, repeat 200cc bolus. However, it doesn't give any drip rate following the bolus(es). For instance, yesterday I had a cancer patient who was dehydrated from vomiting all weekend from an adverse reaction to chemo she received on Fri. She was hypotensive at 90/60, P-120 Reg., R-16 Reg. I gave her the 200cc fluid bolus, and then ran the drip at 100cc/hr. (This is my preference, as I said it doesn't state any in the protocols) Upon arriving to the ER, (15 min/txp), her BP was up to 120/60 and she said she felt better and her pulse went down to 90 Reg. Now is she was massively hypotensive, and symptomatic, I would have went large bore wide open, obviously. I'd just like to get a feel for what others do for mildly hypotensive/dehydrated patients. Thanks!!

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The above is my thoughts/opinions only and doesn't reflect that of any dept./agency I work for, am a member of, or deal with. http://www.firehouse.com/forums/biggrin.gif

[ALSfirefighter]

Sorry, but this is a cheap ploy to get it on the "today's post" list, so I may actually get some input. http://www.firehouse.com/forums/confused.gif

[Canmedic]

We don't have a specific protocol for fluid resucitation other than the standard 20ml/kg for trauma and massive fluid loss; anything less "severe" would be up to the medic as to the fluid replacement. I generally go with a 250cc bolus, reassess, repeated prn.

Mike Kesthely
FF/EMT-P
Lethbridge Fire Dept

[N2DFire]

All of the following are dependant on Pt size/weight/age & medical Hx.

Bolus: Increments of 50, 100, or 200 CC
with full vitals & re-evaluation of pt between each bolus.

Canula: Largest usable size up to 18 ga max for non-traumatic resuscitation. (personal preferance issue here - don't like stabbing a garden hose into someone for "mild" fluid replacement).

Drip Rate: Anywhere from "Fast KVO" to wide open.

Take Care - Stay Safe
Stephen
FF/Paramedic

[Big Zee]

A word of caution here, if the pt. has hx of ca., chemo, and recent vomiting - her electrolytes are off balanced, especially the ones used for hemodynamic stability like sodium, calcium, potassium. If her LOC, cap. refill, color, distal pulses, resp. rate are stable be very careful with large and fast amt's of fluids - you just might put this pt. into CHF or APE. You would be better off with a moderate rate of LR. I know we all learned to look at the numbers, but first look at the pt's clinical signs - what's happening distally? (head, hands, feet). Our practice parameters indicate to administer 200-300cc IV bolus, followed by an evaluation then repeat if B/P < 90. But remember these are only guidelines, nothing can replace experience, knowledge, a proper assessment and using your head.

[ALSfirefighter]

Big Zee,

I agree and took that into account. Only difference is here we do not carry LR we only use NS. After the 250 CC bolus she went up to 120/60 but still looked fluid depleted. Whicch is one reason why I like, and use the 100ml/hr, is that for the 20 min. trip she only received approx. an additional 34 Ml's of fluid. (I rounded it off, from 1.66 Ml's/min x 20 mins.) If she was still under 100-110 SBP, I would have given her another 200 Ml's. I feel that the 100/hr rate is a fair moderate amount.

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The above is my opinion only and doesn't reflect that of any dept./agency I work for, deal, with, or am a member of. http://www.firehouse.com/forums/biggrin.gif