|
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
|