Shock and Fluid

Therapy

Lesson Six

MSTC, FT LEWIS WA
 Outline
► IV Access

► Types of Fluids

► Shock

► Fluid Therapy
 IV
IV Access
Access
►18 gauge IV catheter preferred in the
field setting because of increased
success rate

► Only
started on casualties that need or
may need fluid resuscitation

► Large bore 14 gauge located in CLS bag

 Primarily used for NCD
 Initiate a Saline Lock

► Advantages
 Maintains IV access

 Eliminates administration of unneeded

fluids

 Prevents the need for new venipuncture

each time medication or fluid is to be
given
 Initiate a Saline Lock
► Equipment needed
 2-18 Ga catheters

 Saline lock adapter plug

 Syringe filled with 5 cc sterile saline for flush

 Alcohol wipes

 Tegaderm dressing
Saline Lock
Saline Lock
Saline Lock
Saline Lock
Saline Lock
Saline Lock
 IV
IV Access
Access
► Select a site
 Antecubital fossa or back of hand most
common area
 If possible the non-dominant arm

► Subclavianor internal jugular

venipuncture, and Cutdowns are not
appropriate on the battlefield
 TYPES OF IV FLUIDS
► Crystalloid
 Normal Saline
 Lactated Ringers
 Solution that do not contain protein, other large molecules,
do not remain in the vascular system very long.

► Colloid
 Hetastarch (Hextend)
 Contain protein, sugar or other high molecular weight
molecules, used to expand intra-vascular volume. Replaces
NS and LR
 Normal Saline
(NS, 0.9% NaCl)
►Indications
 Solution of choice for blood transfusion
►equals sodium and chloride in plasma

 To restore body fluids

►90 grams of sodium chloride per 100 ml of water
 Ringer’s solution or
Lactated Ringer’s (LR)
► Indications
 Solution of choice for burns
 Most cases of dehydration
 Supportive treatment of trauma

► Isotonicsolution that replaces

electrolytes
 Hextend
Hextend
► Retained in intravascular space

► 500 cc of a colloid such as 6% hetastarch results

in an initial intravascular volume expansion of
almost 800 cc

Volume expansion sustained for at least 8 hours.

 Hextend
Hextend vs
vs Lactated
Lactated
Ringer's:
Ringer's: Weight
Weight
Considerations
Considerations
► 1500cc blood loss

► Four hour evacuation

► Requires infusion of 1000cc of Hextend

 Weight: Two Pounds

► Approximately eight liters of lactated ringer's (about 20 lbs.)

to achieve the same effect

► Colloids reduce the carry weight and volume by up to 75%

► Question: Where does the extra fluid go?

 Shelf
Shelf Life
Life and
and Storage
Storage
Requirements
Requirements
► Important considerations for resuscitation
fluids to be used in military operations

► Similar for crystalloids and colloids

► Shelf life is 2 years

► Recommended to be protected from

freezing and from exposures to
temperatures above 104 degrees Fahrenheit
 Shock
► Assessment for Shock
 Lack of a radial pulse (indicates BP <80)

 Decreased mental status (lack of perfusion to

vital organs

 Cool, clammy, pale skin

 Tachycardia

► Keys for fluid resuscitation are lack of a

radial pulse and/or decreased mental status
Prevent Or Control
Shock
 Perform First Aid To
Prevent Or Control Shock
Shock: Failure to provide adequate oxygen to all
parts of the body.

 There are several causes of shock.

 On the battle field hypovolemic (low blood volume)
shock will be the primary type of shock present
 If not treated, shock can result in death.
 Perform First Aid To
Prevent Or Control Shock
Hypovolemic shock is usually caused by severe bleeding
but can also be caused by severe loss of body fluids from:

 Severe burns on 20 percent or more of the body surface

 Vomiting
 Diarrhea
 Excessive sweating
 Perform First Aid To
Prevent Or Control Shock
her indications of hypovolemic shock include:

weaty but cool (clammy) skin, pale skin color, and/or blotchy
r bluish skin around the mouth
Nausea
Anxiety (casualty restless or agitated)
Change in level of consciousness such as mental confusion
ncreased breathing rate
Unusual thirst
 Perform First Aid To
Prevent Or Control Shock

POSITION THE CASUALTY TO PREVENT/CONTROL

SHOCK

Take measures to prevent or control shock after you:

 Restore breathing (if needed)

 Control any major bleeding
 Dress any major wounds
 Perform First Aid To
Prevent Or Control Shock
Normal Shock Position
Move the casualty to cover, if possible
Position the casualty on his back
If possible place a poncho or blanket under the casualty
 Perform First Aid To
Prevent Or Control Shock
Elevate the casualty's legs so that his feet are slightly
higher than the level of his heart. (This helps the blood in
the veins of his legs to return to his heart.)

BAD BETTER BEST!

 Perform First Aid To
Prevent Or Control Shock
ock Positions for Special Injuries
tain casualties are not placed in the normal position for shoc

spected Fracture of the Spine:

 Do not elevate legs
en Chest Wound:
 Position them sitting up or lying on injured side
en Abdominal Wound:
 Keep the casualty on his back with his knees flexed
ad Wound:
 Suspect spinal injury when severe head is present
consciousness:
 On side with his head turned
 Perform First Aid To
Prevent Or Control Shock
 Reassure the casualty
 Loosen the casualty's clothing
 Keep the casualty from being too warm or too
cool
 Seek help or evacuate casualty (Administer an IV)
 Do not give the casualty anything to eat or drink
 Fluid
Fluid Therapy
Therapy
► Large
IV catheters are needed to administer large
volumes of blood products rapidly

► Nota factor in the tactical setting since blood

products will not be available

►18 gauge catheter preferred in the field setting

because of increased success rate
 Fluid
Fluid Therapy
Therapy

► Larger gauge IVs may have to be started

at MTF

► Common practice to discontinue pre-

hospital IVs upon arrival at MTF because
of concern about contamination of the IV
site
 Fluid
Fluid Therapy
Therapy
1. Controlled bleeding/ no shock:
Saline lock, NO IV fluids required

2. Controlled bleeding/shock:
Saline lock, IV Hespan 500 - 1000cc

3. Uncontrolled bleeding:
Saline lock, NO IV fluids
 Fluid
Fluid Resuscitation:
Resuscitation:
Uncontrolled
Uncontrolled Bleeding
Bleeding
Weight of evidence at this time favors
withholding aggressive IV fluid resuscitation in
patients with uncontrolled hemorrhage from
penetrating thoracic or abdominal trauma until
the time of surgical intervention.
 Fluid
Fluid Therapy:
Therapy:
Controlled
Controlled Bleeding
Bleeding
Immediate fluid resuscitation is still
recommended for casualties on the
battlefield whose hypo-volemic shock
is the result of bleeding from an
extremity wound which has been
controlled.
 QUIZ!

1) List 4 causes of hypovolemic shock.

2) Indicate how each of the following casualties should be

positioned if he has the condition indicated with no
additional
injuries.
a. Open abdominal wound.
b. Open chest wound.
c. Arm wound with severe blood loss.
Questions????