ALS IV Directive

Question 1

What are the indications for the IV and Fluid Therapy Directive?

Answer 1

Actual or potential need for intravenous medication OR fluid therapy.

Question 2

What are the conditions for IV cannulation?

Answer 2

≥2 years of age

Question 3

What are the contraindications for IV cannulation?

Answer 3

Suspected fracture proximal to the access site.

Question 4

What are the conditions for a 0.9% NaCl Fluid Bolus?

Answer 4

• Age ≥2 years
• SBP - Hypotension

Question 5

What are the contraindications for a 0.9% NaCl Fluid Bolus?

Answer 5

Fluid overload.

Question 6

What is the TKVO amount for ≥2 years to <12 years?

Answer 6

15 ml/hr
No infusion interval, reassess time, or max. volume.

Question 7

What is the TKVO amount for ≥12 years?

Answer 7

30-60 ml/hr
No infusion interval, reassess time, or max. volume.

Question 8

What is the mandatory patch point in the ALS IV directive?

Answer 8

Patch BHP for authorization to administer 0.9% NaCl fluid bolus to hypotensive patients ≥2 years to <12 years with suspected Diabetic Ketoacidosis (DKA).

Question 9

What is the bolus amount for ≥2 years to <12 years?

Answer 9

20 ml/kg, reassess every 100 ml, max 2000 ml.

Question 10

What is the bolus amount for ≥12 years?

Answer 10

20 ml/kg, reassess every 250 ml, max 2000 ml.

Question 11

When is the max volume of NaCl bolus lower?

Answer 11

• Cardiogenic shock
• ROSC

Question 12

What is the lower bolus amount for cardiogenic shock or ROSC pts?

Answer 12

10 ml/kg or 1000 ml.

Question 13

How many BPs indicating hypotension are preferred prior to bolusing?

Answer 13

2, 1 being manual.

Question 14

If after starting an IV the pt becomes normotensive, how much fluid must run minimum before we can dicontinue the IV?

Answer 14

Peds - 100ml
Adults - 250ml
(This is total from IV start)

Question 15

Why do we need to patch before bolusing a pt who is ≥2 years to <12 years with suspected Diabetic Ketoacidosis (DKA)?

Answer 15

So a physician can carefully control the volume of fluid administered to prevent cerebral edema.

Question 16

What are the ALS IV Clinical Considerations?

Answer 16

• “PCP Assist IV” authorizes a PCP to cannulate a peripheral IV at the request and under the direct supervision of an ACP. The patient must require a peripheral IV in accordance with the indications listed in this Medical Directive. PCPs authorized for PCP Assist IV are not authorized to administer IV fluid or medication therapy.
• Microdrips and/or volume control administration sets should be considered when IV access is indicated for patients <12 years of age.
• An intravenous fluid bolus may be considered for a patient who does not meet trauma TOR criteria, where it does not delay transport and should not be prioritized over management of other reversible causes.