Subcutaneous fluids (less skilled than IV) ??

[InTheBlack]

Learning how to give IV fluids isn't something you can find someone to teach you in an afternoon - and monitoring blood volume is a vital skill that must go along with it and isn't as simple.

For a pandemic flu situation where you are bunkered down--

What about subcutaneous (SubQ) administration of fluids instead? A bolus is absorbed slowly by the body.

I learned it easily for small animals, but elderly pets have much thinner skin than humans.

I don't know if it would be helpful during ARDS (leaking fluids everywhere) but prior to or during recovery ???

[haztacmedic]

In the Black: Not to be a smart ass here but you are also in the dark when it comes to this subject. The only place I have ever seen the idea of SQ IV fluids pushed is a comical book titled ditch medicine. IV skills are in fact taught during an afternoon quite often.....You need to be a reserve component soldier and be entered in ATRRS for a combat life saver course to attend though.

"Monitoring blood volume" in the field is not an exact science....I assume you mean monitoring a patient's level of consciousness, skin color, pulse , respirations and perhaps blood pressure (a late sign) for hypovolemic shock?

As for ARDS and pandemic flu....you wont get that in a CLS class. SQ IV fluid is controversial and if you cannot start a real IV I would recommend waiting for the next level of care to come along.
HTM

[medicerik]

Getting signed off to start IVs was something that took about four hours in medic school. We got a lecture, practiced on the training arms, and were practicing on each other all in one night.

Now, I know of no way to directly measure someone's blood volume in the prehospital setting. You can estimate that the healthy adult has approximately 70 cc/kg of blood. (children are 80cc/kg and infants are 90 cc/kg) Multiple studies have shown we do quite poorly at estimating how much blood is in the pool forming underneath our bleeding patient. Estimating fluid loss from vomitting/diarrhea or as a result of increased capillary permiability in the septic patient is going to be even harder. You can measure overall perfusion in the field by looking at level of conciousness, heart rate, blood pressure, urine output, etc. One very easy way to tell if you have someone hydrated well enough is if they are able to urinate. When someone gets hypovolemic, the kidneys are one of the first organs that blood is shunted away from to keep the core perfused.

There is an article in the November 2001 issue of American Family Physician that describes dermoclysis (subcutaneous fluid administration) According to that article, you can get 3 liters of fluid into someone spread over two infusion sites in a 24 hour period. (I can get 3 liters of IV fluid through a big IV with a pressure bag into someone in about 20 minutes) The article describes the technique for use in patients who have mild to moderate dehydration when starting a standard IV is difficult or impractical. This article and the other articles that it references focuses on the elderly or terminally ill patient.

FWIW, the only time I've administered fluid via dermoclysis was in a buddy's cat who was in kidney failure. In the situation you're describing, I'd much rather try and carefully hydrate someone orally (there are all kinds of techniques on how to do this described in the pediatric literature) than go for dermoclysis.

Erik

[Eagle5US]

IntheBlack-

First and only time I will say this. Research your materials and questions prior to posting again.
Further, your pandemic flu example is both poor and unrealistic. Your head can indeed be used for something other than keeping your ears apart. Please find one of these additional uses before posting in the future.

Eagle

[Jack Moroney (RIP)]

Learning how to give IV fluids isn't something you can find someone to teach you in an afternoon
Well actually you can and it is often a team required task for many units. Bevel up:D