Normal Saline

Question 1

Presentation

Answer 1

• 10 ml polyamp

- 500 ml and 1000 ml infusion soft pack

Question 2

Pharmacology

Answer 2

Isotonic crystalloid solution

Composition:
- Electrolytes (sodium and chloride in a similar concentration to that of extracellular fluid)

Action:
- Increases the volume of intravascular compartment

Question 3

Metabolism

Answer 3

Electrolytes:
- excreted by the kidneys

Water

• excreted by the kidneys
• distributed throughout total body water, mainly in extracellular fluid compartment

Question 4

Indications

Answer 4

• replacement fluid in volume-depleted pt’s
• cardiac arrest secondary to hypovolaemia or where the pt may be fluid responsive
• expand intravascular volume in non-cardiac, non-hypovolaemic hypotensive pt eg: anaphylaxis, burns, sepsis
• as a fluid challenge in unresponsive, non-hypovolaemic, hypotensive pt’s (other than LVF) eg: asthma
• fluid for diluting and administering IV drugs
• fluid TKVO for IV administration of emergency drugs

Question 5

Contras

Answer 5

NIL of significance in the above indication

Question 6

Precautions

Answer 6

Consider modifying factors when administering for hypovolaemia

Question 7

Route of administration

Answer 7

• IV

- IO

Question 8

Side effects

Answer 8

NIL of significance in the above indication

Question 9

IV half life

Answer 9

Approximately 30-60 mins

Question 10

Haemorrhagic Hypovolaemia

Answer 10

BP > 70 mmHg

• tolerate hypotension without fluid replacement for up to 2 hrs
• consult if long prehospital times, prolonged extrication or elderly/frail pts

BP < 70 mmHg

• 250 ml IV bolus
• repeat 250 ml IV bolus as required
• titrate to BP > 70 mmHg
• max 2000 ml
• consult if inadequate response

Question 11

Cardiac arrest

Answer 11

In PEA arrest where hypovolaemia, anaphylaxis or asthma is suspected or the pt has a rhythm that my be fluid responsive
- 20 ml/kg IV

All cardiac arrest pt’s

• TKVO IV
• flush all medications with 20 - 30 ml

Question 12

Anaphylaxis

Answer 12

Less than adequate perfusion

• 40 ml/kg IV
• titrated to pt response
• consult for further fluid
• if consult not available repeat 20 ml/kg IV

Question 13

Inadequate perfusion (non-cardiogenic/non-hypovolaemic)

Answer 13

?

• Sepsis
• Chest is clear
• MICA not available
• 20 ml / kg IV over 30 mins

Question 14

Nausea and Vomiting

Answer 14

Dehydrated with Less than adequate perfusion

• 40 ml/kg IV
• consult for more fluid
• if consult unavailable 20 ml/kg IV
• total max 60 ml/kg

Dehydrated with adequate perfusion
- 20 ml/kg IV over 30 mins

Question 15

Burns

Answer 15

pt > 15 yrs with TBSA > 15%

• NS IV @ % TBSA x pt weight (kg) = vol fluid (ml)
• administer over 2 hrs from time of burn

pt 12 - 15 yrs with TBSA > 10%
- NS IV @ 3 x %TBSA x pt weight (kg) = vol fluid (ml)
- given over 24 hrs from time of burn
administer half of the 24 hr fluid volume over the first 8 hrs

pt < 12 yrs - MICA for fluid administration