Normal (Abnormal) Saline vs. Ringer’s Lactate

The choice of crystalloid fluid for volume resuscitation is debated often. With rising concern about the effect of hyperchloremic metabolic acidosis associated with normal saline, clinicians more commonly are opting for balanced crystalloids, such as lactated Ringer’s solution or Plasma-Lyte. 

Intraosseous Access 101

  • IO access provides rapid vascular access in a variety of emergency situations.
  • There are several types of IO devices that can be used.
  • The humeral site is generally the least painful and quickest to access
  • All resuscitation and anaesthetic drugs can be given via the IO route.
  • Fluids need to be administered under pressure.
  • All devices need to be monitored and a clear handover given.

 

Burns Resuscitation

  • Signs of impending airway compromise include: stridor, wheezing, subjective dyspnea, and a hoarse voice.
  • Carbon monoxide (CO) poisoning may manifest with persistent neurologic symptoms or even as cardiac arrest.
  • Burns <15% TBSA generaly require only PO fluid resuscitation.
  • Do not include first degree burns in the calculation of % TBSA.
  • Generally crystalloid solutions should be infused during the initial 18-24 hrs of resuscitation. It is recommended that 5% dextrose be added to maintenance fluids for pediatric patients weighing < 20kg.
  • All resuscitation measures should be guided by perfusion pressure and urine output: Target a MAP of 60 mmHg, and urine output of 0.5-1.0ml/kg/hr for adults and 1-1.5mL/kg/h for pediatric patients.
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Size does matter

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If you want to get big water into your patient, observe the following recommendations:

  1. Gauge is king. Choose the fattest tube you can stick into the patient.
  2. When it comes to catheter length, it’s not the size… it’s how you use it. Shorter catheter lengths mean less resistance.
  3. Consider plugging your drip set directly into the catheter hub instead of using a needle-free adapter or saline lock. The aforementioned study reports significant loss of flow through these types of connectors.
  4. Optimize the pressure difference between the bag and the vein. Place the bag high above the patient and use a compression sleeve, if indicated.

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