intravenoustherapy：静脉注射疗法

《intravenoustherapy：静脉注射疗法》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、IntravenousTherapy74Thirtyyearsago…Rampart,Squad51.Wehavea20yearoldmalemotorcycleriderinvolvedinamotorvehiclecollisioncomplainingofneck,backandlegpain.Hepresentswithcompoundfracturestobothfemursandhassignificantbloodloss.WearerequestinganorderfortwolargeboreIV’sandRinger’sLactate.Objecti

2、vesIdentifythereasonsIVtherapyisperformedintheprehospitalsettingIdentifythefluidscommonlyadministeredStatethebasisoffluidandelectrolytebalanceIdentifyfactorsaffectingwaterlossExplaintherecommendedusesofIVsolutionsIdentifycommoncomplicationsandreactionsCalculateaflowrateDemonstratepropers

3、kincleansingandasepticvenipuncturetechniqueDemonstrateproperIVcannulationtechniqueWhydowecannulate?FluidadministrationMedicationadministrationTomaintainlife(electrolytes,blood…)DowedothemtobeEHSNSprotocolcompliant?IVfluidsNormalsaline(0.9%NS)LactatedRinger’s(LR)AlsoknownasHartman’ssoluti

4、onorRLD5W½NSD5½NSD5RL(D5LR)IsotonicSolutionsCharacteristicsSametonicityasplasmaOsmoticpressureisthesameastheinsideofthecellFluidneverleavesorentersthecellApproximateosmolarityis240–340mOsm/LWillincreasecirculatingvolume,whichmayleadtofluidvolumeexcessoroverload.Solutions2.5%dextrose/0.45

5、%NaCl0.9%NaClLactatedRingers2.5%dextrosein½lactatedringers6%dextanand0.9%NaCl10%dextranand0.9%NaClNormalSalineMostcommonlyadministeredIVfluidprehospitallyIVfluidofchoiceforEHSNSprotocolsWhy?LactatedRingersComposedofmultipleelectrolytesinsalineHasfallenoutoffavorasoneofmainIVfluidsfortrea

6、tmentoftraumatichypovolemiainpastdecadeWhy?HypotonicSolutionsCharacteristicsMaycausebloodcellstoswellandburstMaycausechangesordamageendothelialcellsExertlessosmoticpressurethanthefluidintheextracellularcompartmentFluidisdrawnintothecellsApproximateosmolarity<240mOsm/lSolutions0.45%NaCl10

7、%dextranand5%dextrose(slightlyhypotonic)HypertonicSolutionsCharacteristicsMaycausebloodcellstoshrinkMaycausedame/changestoendothelialcellsExertmoreosmoticpressurethentheextracellularfluidFluidisdrawnfromthecellintothevascularspaceApproximateosmolarity>340mOsm/lSolutions5%