hypertonic saline

[emt-b_wa]

I was part of a team caring for a step one truma where we required airlift northwest and one of the first things they brought out was a 100ml bag labled hypertonic saline for trial use only. Has any one else run into this. What is hypertonic saline and I thought you had to have expresed consent to use trial medications. Any experience and information would be apreciated. Plus I''m interested in the legality of its use.

[MedicRN]

http://www.emtcity.com/phpBB2/viewtopic.ph...ight=hypertonic

[chbare]

Emt-b_wa, check out the prior threads. I believe there was a fairly recent thread on hypertonic saline.

Take care,

chbare.

[vs-eh?]

We are doing this study (which is blind incidently, so you don't actually know what you are giving the patient). Here are the standing orders (as I recall)...

Age >= 15 and/or >=50kg

Blunt or penetrating trauma with SBP <70mmHg or SBP 71-90 with a HR > 108 (I think).

OR

Blunt trauma with a GCS <= 8 prior to any sedation...

CONTRAINDICATIONS...

- Isolated penetrating head trauma (I think it was just penetrating)

- Incident happened > 4 hours prior to arrival

- pt. has received > 2L of any fluid prior

- known pregnancy

- drowning

- pt. is a known prisoner

I don't recall any specific information you have to give to the patient prior to enrolling them. But let's be honest a patient who is eligible is either going to be unconscious anyway or certainly not in a solid mindset to consent. So unless they are a prisoner, they can be enrolled without consent. Also because it is "blind" they technically may not be receiving any type of "new fluid" and may simply be getting NS.

[richard_pfister]

I was part of a team caring for a step one truma where we required airlift northwest and one of the first things they brought out was a 100ml bag labled hypertonic saline for trial use only. Has any one else run into this. What is hypertonic saline and I thought you had to have expresed consent to use trial medications. Any experience and information would be apreciated. Plus I''m interested in the legality of its use.

There's a significant study going on in the Northwest regarding the use of hypertonic saline versus normal saline versus hypertonic saline+dextran in specific patient populations. Issues of informed consent were done in a fashion that passed multiple levels of approval.

The goal is to determine whether administration of a limited amount of hypertonic solutions improves the outcomes for trauma patients. Limited research is inconclusive with some studies saying no, others showing that hypertonic solutions inhibit an inflammatory response thought to lead to patient deteroriation in days post incident.

If patients need additional fluid, they are to receive standard solutions. This is a single-dose item.