EMS Medication Administration - IV Solutions Part One

EMS Providers must have a clear understanding of the different types of IV solutions, including crystalloids, colloids, and blood products, and their appropriate uses to ensure effective patient care in various medical scenarios. 

Here is an overview:

Crystalloid Solutions

Types:

• Normal Saline (0.9% Sodium Chloride): Isotonic solution commonly used for fluid resuscitation.

• Lactated Ringer’s Solution: Isotonic solution containing electrolytes, often used for trauma and burn patients.

• D5W (5% Dextrose in Water): Hypotonic solution, initially isotonic but becomes hypotonic once dextrose is metabolized.

Uses:

• Fluid Resuscitation: Effective for increasing intravascular volume in hypovolemia and dehydration.

• Electrolyte Replacement: Suitable for maintaining or correcting electrolyte imbalances.

• General Hydration: Used in various clinical situations requiring rehydration.

When Not to Use:

• Pulmonary Edema: Excessive fluid administration can worsen pulmonary congestion.

• Severe Hypoalbuminemia: Crystalloids do not replace lost proteins.

Colloid Solutions

Types:

• Albumin: Natural protein solution, often used for volume expansion in hypoalbuminemia.

• Hetastarch (HES): Synthetic starch solution used for volume expansion.

• Dextran: Synthetic polysaccharide used for volume expansion.

Uses:

• Hypovolemic Shock: Effective for rapid volume expansion due to their ability to remain in the intravascular space longer.

• Burns and Trauma: Can be used when crystalloids alone are insufficient to maintain hemodynamic stability.

When Not to Use:

• Coagulopathy: Some colloids can interfere with coagulation.

• Renal Failure: Certain colloids can exacerbate renal dysfunction.

• Allergic Reactions: Risk of anaphylaxis with synthetic colloids.

Blood Products

Types:

• Packed Red Blood Cells (PRBCs): Used to increase oxygen-carrying capacity in anemia or hemorrhage.

• Fresh Frozen Plasma (FFP): Contains clotting factors, used in coagulopathies.

• Platelets: Used for thrombocytopenia or platelet function disorders.

• Cryoprecipitate: Rich in fibrinogen, used in specific bleeding disorders.

Uses:

• Severe Hemorrhage: To restore oxygen-carrying capacity and hemostasis.

• Anemia: When hemoglobin levels are critically low and causing symptoms.

• Coagulopathies: When there is a need to replace clotting factors or platelets.

When Not to Use:

• Volume Expansion Alone: Blood products should not be used solely for volume expansion; crystalloids or colloids are more appropriate.

• Allergic Reactions: Risk of transfusion reactions or infections.

Key Considerations for EMS Providers

• Patient Assessment: Thorough assessment of the patient’s condition, including vital signs, history, and clinical presentation, is crucial to determine the appropriate IV solution.

• Guidelines and Protocols: Adherence to local EMS protocols and guidelines is essential. These protocols are often based on evidence-based practices and can provide clear indications for the use of specific IV solutions.

• Monitoring: Continuous monitoring of the patient’s response to the IV therapy is critical. Look for signs of improvement or deterioration, and be prepared to adjust the treatment plan accordingly.

• Dosage and Administration: Knowledge of the correct dosages and administration rates for each type of IV solution is necessary to avoid complications such as fluid overload or electrolyte imbalances.

• Communication: Effective communication with receiving hospital staff about the IV solutions administered and the patient's response to treatment is important for continuity of care.

Summary

• Crystalloids are generally the first choice for fluid resuscitation and hydration.

• Colloids are used for more aggressive volume expansion but have more potential side effects.

• Blood Products are reserved for situations requiring restoration of oxygen-carrying capacity and hemostasis.

EMS Providers should be well-versed in the indications, contraindications, and potential complications of each type of IV solution to make informed decisions in the field and provide the best possible care to their patients.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell