last week wife had a fight with a stomach bug.  dehydration set in and took her to ER.  typical BS with useless tests to get $$ from insurance

anyway, we are both mil and know how to stick IVs.  going to get IVs for preps and all required tubing and needles.

anyone know of a good hassle free source beside the usual internet search?

TIA

Start here first: http://en.wikipedia.org/wiki/Oral_rehydration_therapy



Get IV stuff if you want it, but start with oral rehydration when someone gets sick.

tried that....for 3 days as soon as she swallowed any fluids it came back up instantly......

This is what we carry overseas on medical missions. I don't like the stuff and would prefer to avoid it, but that's a call for the docs and nurses. 95% of the time oral rehydration works. I prefer a bottle of regular-strength gatorade and a bottle of water in alternating sips.



Yeah, there are still a few places that will sell you some solutions, but I think the sets are harder to get ahold of.
 

no i dont think, its just my cynicism coming out.  just a bit frustrated with some inefficient folks that day.  my main focus was taking care of my wife.  that being said, given hers and mine experience i would hate for either of us, friends or family to be stricken with something like that during hard times and not be able to take care of it.  IV takes care of fluid loss (more than just sickness to a point) and can keep someone from getting worse

Even if you could find some, the shelf live is usually no longer than 2 years on most IV solutions. If you are asking, you most likely don't know this. Knowing how to "stick" an IV and doing it are different things. I don't think I would risk having an expired solution running through myself or someone I love. If you can't be cured with common, over the counter products, use a medical "professional."

yes they have an "expiration date" but for pure saline that is to keep the shelf stock rotated.  i plan on replacing every 2-3 years but im of the opinion its better to have and not need than need and not have

I don't think you're going to have any luck finding a (ligit) medical supply business that will sell you injectables without a drug license. I owned and operated my own BLS EMS service for over 10 years and even ran in to a few suppliers who wouldn't sell my company irrigation saline (even though it's not a restricted / controlled "drug").

having just dealt with this yesterday i can tell you, just because you think you know how to start an IV doesnt mean you can do it when needed. i have been in the EMS/fire service for over 13 years now and was in the ER yesterday for severe kidney and right flank pain caused by a 9x4mm kidney stone. it took 5 tries before the nurses could get a stick because i was so dehydrated. they do this every day and if they have trouble with it how do you think your going to be able to do it on a whim? unless its something you do every day its not something your going to be able to do just because. leave those skills to the people that do it for a living.

So what are your thoughts on 9mm vs. .45?  



 

A trick I learned from our pediatrician is this:  1mL every 15 minutes.  It sounds awfully small - and it is - but it is usually small enough that a person can keep it down.  When my 1-year-old had rotavirus for a solid week, that was the only thing that kept him good enough that he didn't have to stay in the hospital.

You can SLOWLY increase the amount - say, 1mL every 10 minutes, and so on, but increase SLOWLY, because sooner or later, you'll be putting enough in them that they will start horfing it up again, and  you'll have to go back to square 1.  Vomiting will dehydrate you faster than diarrhea, play it safe.

that 9mm hurt like hell. probably the worst one i have had yet. had one earlier this year that was 8x5mm. that sucked to.

I got a shit ton of IV starter kits from my deployments
Now I just need bags of fluid.

Kept away from light sources, in a meticulously cleaned place, preferably in a fridge, I'd trust most IV fluids for AT LEAST 5 years. ringers and saline, I'm not so sure about dextrose.

I keep a stock of oral hydration salts.  We used to drop IV's all the time for dehydration in Iraq, but now that IV's are kept out of the CLS bags we only get oral dehydration salts.  They aren't bad actually, once you get past the taste.

IV fluids are good unless there is crystallization, cloudiness or damage to the bag. but not sure i would trust them 5 years out though. one problem is what do you do if you send someone into flash pulmonary edema? what if you dont have a clean IV site and it gets infected? how about an infiltrated IV site? there is more to it then just sticking a needle in someone.

Stick what, where now!!!
If you are talking about an IO, you are way the fuck out of your mind. Remember this word. Osteomylitis. Think of it as a bone infection that will cost you your leg. They are a shit ton easier to place than IV's, however, they require proper sterile technique, equipment and training beyond common practice. Stick with hydration pills as stated earlier.

you are bolth in the military and you had to go to a civillian hospital and PAY for it? That sounds like a double ass pounding.

Knowing how to start an IV(even if you're good at) is just a small part of the process. A monkey could start an IV, the important part is the knowledge of flowrates, solutions, med interactions, pt hx etc. There is a reason that you can't get IV without a script.

Also, to the poster who suggested going into the tibia. I'm guessing you're talking about I/O stuff but if you're referring to starting an IV in the leg then that's a very dangerous area and should only be attempted by trained people. The risk of dislodging a DVT far outweighs the benefit of an IV access site..

we had a really good thread on this subject a couple years ago.  I think the consensus was that most people dont know how to use them well enough to justify it, combined with shelf life issues.

8x5 millimeters????  thats the size of a cube of sugar. how the hell did you piss that out??

would you believe im "well hung"?

seriously, i had lipotripsy which is what im trying to get scheduled ASAP for the right kidney. all you do is piss out bits and pieces after that. very little pain if any. on the first one i actually controlled the pain with advil. the Dr was like then told me i was his hero because almost everyone else wants pain meds. pain meds and i dont get along well so i try to hold of as best i can. this time it started at 0045 on a friday night/sat morning and i dodt go to the ER till monday afternoon. that was a HUGE mistake. should have gone sooner. oh, and that first one, te one that was 8x5 was shaped like a heart and happened just before valentines day. LOL. guess this one is my fathers day present.

OK, I'm not going to bash anyone for wanting IV's. When I was in EMT school we stuck ourselves for practice quite often.  No one got pyrogenic infections or died of an embolism.  Can't tell you how many times we discontinued IVs in the field without killing the patient. There is indeed risk, but if I am needing an IV badly enough I'll let any one of you blokes stick away.

However, keeping things simple- I'm going to mention this: Has anyone looked into rehydrating via enema?

it works....you can even use sea water....so I've read.....ahem.....no real experience on the matter.

easy answer....how well do you know your veterinarian?

Pretty much sums it up.

This is in reference to an enema, right, and not IV fluids?!?



 

The subject of rectal hydration was discussed fairly well in the aforementioned thread a few years ago.

Unfortunately, most folks seemed to dismiss it to focus on IVs instead of this more feasible SHTF technique, for some reason.

Maybe they just want the gear and not the 'solution'?

But IDK.

I DO know that it's in our toolkit.

Since nobody else will do it I will........These guys have not required anything from me so give em a try.............Of course I dont do IV sticks my wife does as shes an RN..........IV LINKY

Again, I believe you're missing the point. The main issue here is not the ability to gain IV access. Initiating and discontinuing an IV is the easy part(actually it's fairly difficult on a pt who truly needs one) of the process. That's why many facilities allow non-licensed personnel to do these procedures. The meats-n-potatoes comes with the knowledge of what and how long to put into said IV site.

The fact is starting a 16g IV on a obese black guy, who's dehydrated and in shock, at night, in the rain calls for some serious bragging rights. Not to mention showing off your IV supplies to your buddies is damn sexy too. All that being said, in a SHTF situation I'd rather not risk an infection of an IV site on a pt with no higher level of care available.

enema

I'm sure you guys have this covered but it's worth mentioning that there a number of decent anti-emetic meds out there. Ondansetron in particular. It's good to have access to them to, potentially, obviate the need for IV fluids. Won't always work, but it'll work more often than not in the case of a vomiting illness.

+1 have got many cases myself. Wife is BSN/PA.

I've used the injectable and that stuff is like magic.



Also, I know it may be falling out of favor, but I carry oral Phenergan when I travel. Ask your doc for a script.



 

amazon?

Never tried it before

Maybe not quite what you asked, but  it's not unusual to give fluids rectally in the third world.

I mean, you'll probably need a new mouthpiece for your camelback  ...  

No, you can't (assuming the goal is hydration.) You can use non potable water (rainwater contaminated with salt, insect deritus, plastic flakes, etc), but you need to be reasonabally salt free.

This topic got locked last time.  While it is medically recognized, has been done in the recent past, and is completely legal, it makes some people squmesh.

Look at it as a good step for the layperson between oral rehydration and  IV fluids, and in some cases the prefered option depending on water quality.

Both DOD and the US government (thinking NPS, USFS, and BLM) consider it to be a very minimal risk procedure given minimal training.  You can't allways get it to work (especially if you lack the manual skill of a busy EMT-P, ER nurse or similar)  It's not hard to keep a sterile site, and there are minimal contrindications.  It's a valuable intervention in certain cases (pandemic flu and food poisioning) commonly discussed here.  In the case of trauma or use for IV drug access, it's probally a lot less valuable when definitive care isn't available.

I don't know how wide spread it is, but DOD seems to be pushing chilled fluids for heat injuries,  CHilled fluids wide open via a large bore cath in one arm, room temp fluids TKO in the other.  Aparently a single bag can drop the the core temp nearly a deg F (Counterintutive,but the fuids don't circulate to the extrimities to the same degree as the core).  

When we had the swine flu scare last year, the first question my wife (who holds and MD)  asked me was how many cases of IV fluids we had.

DIY oral rehydration mixture:



http://www.ehow.com/how_5564304_stock-flu-oral-rehydration-solution.html

We stock plenty of IV - multiple types. Wife is ninja RN and is also an excellent teacher for lug nut heads like me to learn from.

for those that want to know.  Amazon is your friend, no middle man required

We just need to develop the industry's first "tactical enema" kit.  Then it'll be all the rage......  

I've never considered IVs difficult, but it's been a long time since my first stick. To me, enemas seem a much more practical way for the layperson to hydrate someone. In a long term scenario I imagine enemas would be used for illness, IVs would be saved for acute events.  I'll have to look closer into it

You can't give an enema to a person who has diarrhea.

If you are both military, just go to your medics.  If you know how to do sticks, you are likely already CLS (or something similar if you are not Army), you should have some anyway.  Go to your medics, ask them if there is any way you can get a case of NS or better yet Ringers.  Almost everything I carried when I was a .mil medic was Ringers.  I carried a few 500's or NS for secondary lines in trauma, but probably 75% of what I had, and 95% of what I used was Ringers.  
I wouldn't even try going through civilian channels, IV fluid is a prescription.  In the .mil it is not.

For dehydration, bolus until empty, hang a second bag, bolus that one too. Usually your patient has improved.  So easy a monkey can do that part too.

Pulmonary edema, so easy a monkey can cause it.

 

Okay so what if you're treating a 15kg child for dehydration/nausea/vomiting?  Are you advising people to bolus 2000ml of IV fluid into a child?  

Your advice is reckless IMO.  

Just because they showed you a few times in a Combat Lifesaver Class doesn't make it that easy to do.  Trust me I do hundreds of IV's a week and even sometimes I miss.  Plus like has been mentioned before you can cause major issues that can kill someone.  Compartment Syndrome  among many other.  But hey...it's cool for you guys an its your limbs...well worth the savings of a few dollars.

I think most .mil guys get mis-informed on the usefulness of IVs. When I was trained as a CLS in the USMC, starting IVs was a no brainer after a few successful sticks. With the logistics/manpower of only having one or maybe two corpsmen per platoon it made sense to have a few extra guys that could start a line.

Once I got to the civilian-side of it, I realized that the easiness of IVs in the mil is based on sticking relatively young people in good shape. Even if they were dehydrated, it was relatively simple to find a suitable vein. And I was only concerned with the sticking part.

Also the mil training was based on stabilizing the pt as much as possible and focused on packaging and calling in the medevac.

Since this is a topic concerning IVs in the SHTF world, there won't be a higher level of care to transport to. If there is you may be having to answer some questions when the pt shows up at the ER with an IV in their arm. Good Samaritan laws be damned.


Don't get me wrong, IVs most definitely have a place. The problem is you really need to know what the hell you're doing and you can't get that type of training in an EMT-B course or a CLS class.

The Op was talking about his wife, and tx his wife for dehydration.  If his wife is a 33lb kid, then there are other issues at play here.  Why in the flying fuck is it assumed that common sense has no play in first aid???  We talk all the time on here about double tapping an intruder and it is taken for granted that if the intruder is a 33 lb kid, you don't double tap them.  We talk about pulling security when TSHTF, but we don't assume that 33 lb kids will be pulling security.  We talk about hunting game, we don't assume the hunter is going to be a 33 lb kid, nor do we assume the game is going to be a 33lb kid.  WHY IN THE HELL DOES THE PATIENT ALWAYS HAVE TO BE ONE?????  AND WHY THE HELL DO WE ASSUME NO ONE IS SMART ENOUGH TO REALIZE THAT THE PATIENT IS A 33LB KID, BUT HAVE NO PROBLEM ASSUMING THAT SAME GODDAMN PERSON IS SMART ENOUGH TO FIGURE OUT THE DIFFERENCE BETWEEN A KID AND A DEER OR A KID AND AN INTRUDER?  HOLY FLYING FUCKBALLS BATMAN!  Just because the AMA says IV's are superinvolved ALS, doesn't mean with a little bit of training, your average person can't use them to treat dehydration on his wife.  Holy hell, we let Marines start IV's!

I get that with the introduction of major illness and the delivery of meds and extreme geriatric/pediatric situations, and with long term and repetitive use, or any combo there of, things get more complicated.  Schooling and experience are needed, and it would be patently impossible to use them without a couple of additional initials after your name.  But look at it this way, a hemostat is used for very delicate clamping of cardiac blood supply during pediatric heart surgery, which takes definite knowledge and training, but that doesn't take the use of hemostats away from your average person to get out a splinter.  

ETA:  another analogy:
   Guns.  Guns are dangerous.  They can cause death.  They can cause penetrating trauma.  They can poke out your eye.  Laying consistent suppressive fire to area and point targets at range is very difficult.  So, ONLY THE MILITARY SHOULD HAVE GUNS!  Leave it to the professionals before someone gets hurt.  What if it was a 33lb kid for crying out loud!

ETAA:  Looking at your screen name, its pretty obvious you are an anesthesiologist.  So, what you use an IV for is pretty complex.  Obviously, like I said earlier, there is no way it could be done without the extra letters behind your name, because med school means you are in fact better than the rest of us.  I guarantee you are better than your average CLS guy at needle sticks.  Because you went to med school.  *cough*
However, what you do is way different than 90% of situations that the could be used in.  


The single largest employer in the US (other than walmart) lets people start, utilize and dc IV's after a paltry 16 week training course, the first 8 weeks of which are an EMT certification.  IV training is a 3 week portion of the overall course, and that same three weeks also addresses intubation and basic surgery (in the field none the less!).  Once they graduate, they are capable of and pretty much required to start IV's and dc them with no continuation to a higher level of care just because an IV was utilized.  Oh yeah, did I mention that these were largely 18 y/o's doing this????   Then, this is the best part, that same 18 year old then goes out after just 16 weeks of medical training, trains other 18 year olds to start and administer IV's in a class that, on paper, is only 40 hours long, but in reality usually takes place o 3-4 4 hour days.  The best part?  I spent 8 years in this cycle, training CLS, running an aid station, running an ambulance platoon, Air evac, line medic, you name it, I did it, and not once did I see someone die or get a serious injury from an IV.  I saw some strange shit, people starting an IV the wrong direction, pulling out the catheter, not the needle, all kinds of crap, and no one died.  Sure, get a big enough group of ppl, and someone, somewhere will die.  Of course, someone somewhere dies eating a hot dog every year too.

And now no one messes with your toolkit :-)

I remember enema bags in the locally owned drug store when I was a kid, now reusable stuff is almost imposable to find through medical channels.  However google "Tyler Labs" if you don't mind purchasing from a sexual fetish shop.  Not cheap, and IIRC, the tubing was Latex (not an item for long term storage, so I replaced with poly tubing from the hardware store)

Disposable bags are available, but IIRC, they were pretty expensive for what looked like would only survive one time use.  Or just find some larger bulb syringes.

Not to to be dismissed is the threat of an enema making one do a better job of hydrating themselves.

i will see your rant and raise you, one of our medics sent a woman(42YO) into flash pul edema by giving her a 250cc bolus and leaving the IV(20g needle) wide open for less than 15 min. flowed just under 500cc in her. the call was for dehydration from nausea, vomiting and diarrhea x3 days with NO intake. again, if you dont know what your doing and what to look for and the tools and training to go along with both, you shouldnt be talking about it much less actually doing it.