Normal Saline Flashcards
Presentation
- 10 ml polyamp
- 500 ml and 1000 ml infusion soft pack
Pharmacology
Isotonic crystalloid solution
Composition:
- Electrolytes (sodium and chloride in a similar concentration to that of extracellular fluid)
Action:
- Increases the volume of intravascular compartment
Metabolism
Electrolytes:
- excreted by the kidneys
Water
- excreted by the kidneys
- distributed throughout total body water, mainly in extracellular fluid compartment
Indications
- 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
Contras
NIL of significance in the above indication
Precautions
Consider modifying factors when administering for hypovolaemia
Route of administration
- IV
- IO
Side effects
NIL of significance in the above indication
IV half life
Approximately 30-60 mins
Haemorrhagic Hypovolaemia
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
Cardiac arrest
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
Anaphylaxis
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
Inadequate perfusion (non-cardiogenic/non-hypovolaemic)
?
- Sepsis
- Chest is clear
- MICA not available
- 20 ml / kg IV over 30 mins
Nausea and Vomiting
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
Burns
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