IntravenousTherapy静脉注射疗法.pptxVIP

IntravenousTherapy静脉注射疗法会计学Thirty years ago…第1页/共45页Rampart, Squad 51.We have a 20 year old male motorcycle rider involved in a motor vehicle collision complaining of neck, back and leg pain.He presents with compound fractures to both femurs and has significant blood loss.We are requesting an order for two large bore IV’s and Ringer’s Lactate.Objectives第2页/共45页Identify the reasons IV therapy is performed in the prehospital settingIdentify the fluids commonly administeredState the basis of fluid and electrolyte balanceIdentify factors affecting water lossExplain the recommended uses of IV solutionsIdentify common complications and reactionsCalculate a flow rateDemonstrate proper skin cleansing and aseptic venipuncture techniqueDemonstrate proper IV cannulation techniqueWhy do we cannulate?第3页/共45页Fluid administrationMedication administrationTo maintain life (electrolytes, blood…)Do we do them to be EHSNS protocol compliant?IV fluids第4页/共45页Normal saline (0.9% NS)Lactated Ringer’s (LR)Also known as Hartman’s solution or RLD5W? NSD5 ? NSD5RL (D5LR)Isotonic Solutions第5页/共45页CharacteristicsSame tonicity as plasmaOsmotic pressure is the same as the inside of the cellFluid never leaves or enters the cellApproximate osmolarity is 240 – 340 mOsm/LWill increase circulating volume, which may lead to fluid volume excess or overload.Solutions2.5% dextrose/0.45% NaCl0.9% NaClLactated Ringers2.5% dextrose in ? lactated ringers6% dextan and 0.9% NaCl10% dextran and 0.9% NaClNormal Saline 第6页/共45页Most commonly administered IV fluid prehospitallyIV fluid of choice for EHSNS protocolsWhy?Lactated Ringers第7页/共45页Composed of multiple electrolytes in salineHas fallen out of favor as one of main IV fluids for treatment of traumatic hypovolemia in past decadeWhy?Hypotonic Solutions第8页/共45页CharacteristicsMay cause blood cells to swell and burstMay cause changes or damage endothelial cellsExert less osmotic pressure than the fluid in the extracellular compartmentFluid is drawn into the cells