The prepper with medical training must deal with a wide range of medical issues. When you don’t have access to modern medical facilities, bleeding, broken bones, burns, and infections can pose serious problems.
Many of these issues result in fluid loss from the body. What’s lost will be replaced by oral rehydration, but what if your patient is unconscious?
Normally, this is where intravenous (IV) fluids come in. According to one study, nearly 90% of hospitalized patients have an IV line placed.
Hospitals will be few and far between in a true long-term disaster scenario, but injuries and infections will still occur. In most cases, oral fluids will suffice, but it’s a good idea to understand the fundamentals of IV therapy.
IV infusions can be used to maintain hydration, balance electrolytes, replace blood, administer medicine, and even provide nutrition in the right hands. IV fluids can save lives, but they can also endanger them if used incorrectly. So be cautious when administrating IV fluids.
Types of IV fluids
Giving fluids to a person is more complicated than putting gas in a car. Some terms must be understood in order to grasp the fundamentals of IV fluid administration.
A “solute” is a solid that has been dissolved in liquid. Salt in water is a classic example of a solute. The solute that dissolves in a solvent (water in this case) forms a saline “solution.”
“Crystalloids” are IV fluids that contain solutes dissolved in water. They are the most commonly used options for replacing fluids and balancing electrolytes. Fluids in a blood vessel can be either inside or outside the cells (“intracellular” or “extracellular”). “Plasma” refers to the fluid found in blood vessels outside of cells.
Isotonic, hypertonic, and hypotonic are the three main IV fluid tonicities.
Isotonic fluids – Because they have a solute concentration similar to that found in plasma, they do not cause significant pressure movement of fluid into or out of the patient’s red blood cells. The most well-known IV solutions in this category are 0.9 percent “normal” saline, lactated Ringer’s solution, and 5% dextrose in water. These would be used to replenish fluids lost due to dehydration.
Hypotonic fluids – These fluids have lower solute concentrations than blood, resulting in a tonicity lower than plasma. When blood cells contain more solutes than IV fluid or plasma, they swell as osmotic pressure forces water into them. When a patient has extremely high sodium levels or a condition that dehydrates cells, such as diabetic ketoacidosis, hypotonic solutions are used. “Half-normal” saline (0.45%) and sterile water are two examples.
Hypertonic fluids – These fluids have a higher solute concentration than blood. They are typically used in critical care to treat extremely low sodium levels, which can result in fluid buildup in the lungs. The hypertonic solution will aid in the removal of extra fluid from red blood cells. Dextrose 5 percent in 0.9 percent normal saline solution or even 3% saline is an example of hypertonic fluid.
In practice, the prepper medic who is fortunate enough to have IV setups and a supply of isotonic IV fluids on hand will use them to replace fluids lost due to dehydration or, possibly, hemorrhage.
Adjusting electrolytes such as sodium with hypotonic or hypertonic solutions is dependent on knowing the level, which is typically determined by lab tests. Because such tests are scarce off the grid, this requires some educated guesswork.
Deaths from severe dehydration in survival settings can be avoided by administering fluids such as Ringer’s lactate or 0.9 percent normal saline solution.
This is known as “fluid resuscitation.” Water, calcium chloride, potassium chloride, sodium chloride, and sodium lactate combine to form Ringer’s lactate.
Oral fluids can help with most cases of dehydration.
Look for the following signs of dehydration that necessitates IV resuscitation:
- Dark urine in small amounts
- Rapid heartbeat
- Dizziness or fainting
- Dry mouth and lips
- Sunken eyes
- Skin discoloration (“turgor”)
To check turgor, pinch the skin on the forearm. Normally, the skin snaps right back, but will remain “tented” in victims of dehydration. Dehydration is more common in people who have a high fever, are diabetic, are vomiting, are alcoholic, or are overheated.
How much fluid should we give to someone who is dehydrated?
The Centers for Disease Control and Prevention (CDC) recommends 30 ml of Ringer’s lactate (preferred) or normal saline per kilogram of body weight (1 kilogram equals 2.2 pounds) in the first 30 minutes, and 70 ml/kg spread out over the next three hours for those over one year of age.
If the patient’s situation does not improve, you can continue for longer periods of time. This may be necessary for someone suffering from cholera, which causes massive fluid loss through watery diarrhea.
Increased urine volume and color, stronger pulses, good skin turgor, resolution of vomiting, and decreased thirst are all signs of improvement. Once the patient’s condition has improved, the IV may be removed and oral fluids administered.
Oral rehydration salts are commercially available to mix with water, or you can make your own. A liter of water should be mixed with 6 teaspoons of sugar and 12 teaspoons of salt.
You can also add a pinch of bicarbonate (baking soda) and a small amount of salt substitute (potassium source) to the mixture. To improve the taste of the solution, a flavoring agent may be added.
Those suffering from dehydration, vomiting, or diarrhea should begin by sipping the solution rather than gulping it down.
Parts of an IV set
Intravenous infusions necessitate the use of specialized materials. A typical IV setup includes several components for therapy insertion and maintenance.
Intravenous fluids – Fluids such as normal saline or Ringer’s lactate were previously packaged in glass bottles. Today, they are almost always in sterile plastic bags. Bags can range in size from 50 to 1,000 milliliters. Because of the volume of fluids required, liter bags are best for dehydration.
Although most IV bags have a port that allows medication injection into the main bag, small bags like 50 ml are used to deliver dilute intravenous medications.
The IV catheter is basically a hollow, plastic tube that has been pre-loaded over a hollow, beveled needle. The needle/tube is connected to a “hub” that is visible above the skin. Behind the hub is a small, transparent chamber that allows the prepper medic to see when blood from the vein flows into the catheter after a successful insertion. The catheter is then attached to tubing, which is attached to the fluid bag.
IV needles are typically 14 to 24 gauge, a measurement that indicates the internal diameter of the catheter. The narrower the catheter, the higher the gauge. Saline can be infused through small gauge needles, but thicker fluids, such as packed red blood cells, require larger gauge needles.
IV tubing – This is the tubing that connects the IV bags to the IV catheter. It is also known as a primary infusion set. A “spike” is typically used to insert one end of the line into the bag.
The set includes a “drip chamber,” which allows you to estimate the rate at which IV fluids flow down the tubing. It also allows gases to escape from the fluid and prevents them from passing down the IV line.
A roller clamp is provided below the drip chamber to control the rate of fluid entering the vein. Primary infusion sets typically include a port further down through which medications can be injected directly. When the extra length is required, extension sets are available. Before connecting to the catheter, the entire line is flushed with fluid to remove air.
Antiseptics, tape, and tourniquets – Prior to the procedure, the skin at the site is cleaned with alcohol or povidone-iodine wipes. To make the vein easily identifiable, a thin tourniquet band is used above the planned insertion site. Tegaderm or another adhesive is used to secure the line in place after the catheter has been placed and the metal needle has been removed. The date and time of placement are recorded.
Suggestions for setting an IV line
Put on your sterile gloves and connect the IV tubing to the fluid bag.
Flow fluid through the entire line.
Choose a vein on the left arm if the patient is right-handed and vice versa.
Begin with the veins furthest away from the torso and work your way up, but if an IV is required in an emergency, it may be necessary to place it in the crook of the arm.
Apply the tourniquet snugly 20 to 25 cm above the site of needle insertion.
Allow the patient to clench and unclench their fist.
Recognize the vein.
It should appear “bouncy” in comparison to the surrounding tissue.
Don’t slap the vein; instead, flick it with your thumb and second finger to make it stand out.
Using an alcohol pad, disinfect the insertion site in the direction of venous flow.
Pull the skin taut just below the entry site once the alcohol has dried to stabilize the vein.
Taking care not to let your gloves come into contact with the needle or catheter.
Insert the catheter into the vein at a 15- to a 30-degree angle.
Going from the side can cause the vein to push sideways, causing you to miss.
To make the needle glide more easily, make sure the bevel is facing upward.
Untie the tourniquet once the catheter is inside the vein to prevent it from blowing due to increased pressure. Pull the needle gently away from the catheter and out. While connecting the tubing, place your finger over the inserted catheter to prevent blood spillage.
Tape the catheter securely in place and gradually loosen the roller clamp to start the infusion.
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