Circulation Part 2, Fluids

Continuing through Circulation we have just converted any tourniquets we applied and we have rechecked their radial pulse to see if it made any difference. If the Radial pulse is still absent we need to start pushing fluids.

Now when I say fluids I don’t mean Normal Saline or Lactated Ringers. I mean blood. This can start a whole heated discussion in the comments section already, I just know it, so bring it on. Blood is the superior volume replacement. Normal Saline will harm your casualty. Do not try to tell me otherwise. The military doesn’t even use Hextend anymore. Blood collection kits are out there. (just ask any NAR dealer, I wonder who could be one. Hm…) NS has a PH of 5.5, blood has a normal ph range is 7.35-7.45. That is a massive difference. You will send your casualty into acidosis and you will have to spend the rest of your time fighting the lethal triad. If you do not know how to give fluids intravenously (IV) or intraosseously (IO) then do not attempt to learn on the fly. However, there is an alternative.

Rectal IV’s or Ranger IV’s have been in use for many years in austere settings. Everywhere from military units to medical teams in the Himalayas. It has several benefits over a regular IV. Application is much easier on a rectal IV vs a regular IV. You don’t create a site that can allow infection. The biggest benefit has to be that the fluid does not have to be sterile. If it is clean enough to drink, you can administer it rectally. You must add sodium to the fluid or it will have an enema effect on the casualty and that is the last thing we want at this time. You want a 1:100 mixture of sodium and water. And it can simply be table salt. So 10 grams of salt to 1 liter (2 tablespoons of salt and 4 cups) of potable water. I prefer enema bags for this task as I can just fill them with whatever fluid I have.

This is nowhere near as effective as blood. But it’s better than just sitting there.

Have you ever administered an IV before? What about a rectal IV?

Ever done an IO?

By mechmedicPublished On: March 15, 2022Categories: MechMedic, Medical3 Comments

About the Author: mechmedic

MechMedic is the owner of Stuck Pig Medical and medical instructor for Brushbeater Training and Consulting. After 5 years in the beloved Corps, Mech joined the National Guard where he became a medic. Lifelong survivalist, and overall outdoorsman. When not being a family man, he enjoys good bourbon and good cigars.

3 Comments

Sam March 15, 2022 at 14:08

Does a rectal IV have the same PH problems? I know this is likely a stupid question but…I haven’t a clue, so I’m asking. Thanks for the information. Very interesting.
- mechmedic March 15, 2022 at 17:01
  
  No it doesn’t! Because the fluid is being absorbed through the colon, not directly into the blood stream.
Sam J. March 16, 2022 at 00:43

Thank you. That’s a very good thing to know. Now I don’t really know but it seems to me common sense would tell you someone with a lot of blood loss could get fluids into the body much faster rectally because of the huge Colon area than you could with a IV.