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EMS I.V. Fluids

Hardcastle Tim, Dr <tch at sun.ac.za> tch at sun.ac.za
Thu Jul 21 14:02:48 BST 2005


Yes

Balsol Per litre:
Na 130 mmol/l
K 4,0 mmol/l
Cl 110 mmol/l
Mg 1.5mmol/l
HCO3 27mmol/l

Osmolality 273

Ph = 7,4 - the real advantage!

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
General Surgeon (Trauma and ICU)
ATLS and DSTC instructor
Intern program Coordinator: Surgery
Program Manager: Emergency Medicine (U.S.)
Operational Head: Diana Princess of Wales Trauma Unit
Department of Surgery Room 4064
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa

2 Lorient Close
Vredekloof, Brackenfell
7560, Western Cape,
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302
Home: +27219813098


-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of morgan mcmonagle
Sent: Thursday, July 21, 2005 2:51 PM
To: Trauma & Critical Care mailing list
Subject: RE: EMS I.V. Fluids


I just looked it up in the BNF and on-line, and,
there's nothing here by that name! Is it definately
bicarbonate in the bag?

Morgan


--- "Hardcastle Tim, Dr <tch at sun.ac.za>"
<tch at sun.ac.za> wrote:

> Morgan
> 
> Just means I've got the non-SA trade name wrong. Do
> you have something called Balsol in the UK?
> 
> Tim
> SA
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]On Behalf Of
> morgan mcmonagle
> Sent: Thursday, July 21, 2005 2:36 PM
> To: Trauma & Critical Care mailing list
> Subject: RE: EMS I.V. Fluids
> 
> 
> Plasmalyte contains acetate (and some gluconarate)
> as
> bicarbonate precursors, which are metabolised to
> bicarbonate in the peripheries, esp. muscle
> (assuming
> it's being perfused), but does not contain
> 'bicarbonate' as such). RL of course, uses lactate
> as
> it's bicarbonate precursor, relying on hepatic
> metabolism...which is highly unlikely to be a
> problem
> with a normal liver, even after major trauma.
> 
> Morgan McMonagle
> UK
> 
> 
> 
> --- "Hardcastle Tim, Dr <tch at sun.ac.za>"
> <tch at sun.ac.za> wrote:
> 
> > That is why if you have a crystalloid called
> > Balsol,it is the most physiologically balanced
> > (Plasmalyte L in the USA???). It has the bicarb in
> > it, so no liver phase required, with elecs
> > equivalent to plasma. In South Africa this costs
> > equal to a NS or RL. We use it as the fluid of
> > choice in the OR / theatre.
> > 
> > Tim
> > South Africa
> > 
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org]On Behalf
> Of
> > stealthmedic at adelphia.net
> > Sent: Wednesday, July 20, 2005 2:57 PM
> > To: trauma-list at trauma.org
> > Subject: Re: EMS I.V. Fluids
> > 
> > 
> > We only carry NS. we used to carry/use D5W, LR and
> > NS to use in different type calls. The rational
> > given by our MD, (Medical Diety) who is a trauma
> > surgeon, is that a pt in a shock or near shock
> > (compensated) state is poorly perfusing the liver
> as
> > part of vasoconstriction and /or direct injury.
> The
> > liver metabolizes the lactate componenet but
> doesn't
> > in this case and that causes problems. I'm sure
> > there is more chemistry to this but that is the
> > short version.  Carrying only one fluid simplified
> > protocols, NS can be used for seizure pt d/t
> > compatability issues w/ drugs, at KVO rates or prn
> > access does not harm cardiac pts and is a short
> term
> > volume expander / b/p supporter in theory but I'm
> > having my doubts after reading this list. It did
> > make carrying the drug box and supplies smaller
> and
> > lighter by only carrying one flavor of fluid. Our
> > protocols are under revision and w/ 17 hosptials
> and
> > even more agencies OMD's, paid/volunteer and
> > urban/rural areas its like herding cats. Who knows
> > what we'll be doing next to our pt in the field. I
> > like the KISS method of just NS especially if no
> one
> > can show consistant outcome data.
> > 
> > ---- Roger Ekins <remt14 at msn.com> wrote: 
> > > Hello I work in a rural E.M.S. system and the
> > local debate is which I.V. fluid to hang, L.R. or
> > N.S. and which to use in trauma or medical. I am
> > interested in your opinion.
> > > 
> > > Roger
> > > 
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