why can't we give water?

[bandaidpatrol]

Local protocols tell EMS to give water PO to people with heat illness, and orange juice to diabetics who are C/A/O.

We used to give water with ipecac, frowned upon now, but compared to modern EMS.. I worked in the dark ages.

[cosgrojo]

Emergently, I think everyone has covered all the bases. But there are reasons as well in non-emergent transfers. Possible fluid restiriction secondary to CRF, critically low-sodium content, and (as noted with emergencies) aspiration precautions. When getting report from staff, they do not always inform you of these conditions, so best to not give at all. If a long transfer, it would be prudent to ask before transport, just in case they ask. CRF pt's are always trying to trick EMT's into giving them something to drink. Those who don't know what CRF is are sometimes fooled, some pt's can get a bit beligerant when they sense you might give in to their request. Rule of thumb, if the pt is very intent on having something, chances are they shouldn't have it. Be carefull.

[JoelEMT]

Please define CRF. Thanks

[cosgrojo]

Chronic Renal Failure.... Reason why people need dialysis. Kidney failure. Kidney's totally unable to filter the water in your body, causing inability to urinate, retention of fluid in your system.... overall bad stuff. There are fluid restrictions on these people. Too much fluid=death.

[bandaidpatrol]

"Drowning from the inside - out"

[Doczilla]

Many patients have to be kept NPO (nothing by mouth) for a variety of reasons. The most important ones have been listed already:

1) Risk of aspiration

2) Possibility of surgery

3) Need to restrict/monitor fluid intake

To include in that list:

- Need to "rest" the GI tract, for a small bowel obstruction for example

- possible aggravation of intrabdominal process, such as cholecystitis, pancreatitis, or enteritis.

Since you can rehydrate people IV, there is no urgent need to give them something PO. Given the above potential downsides, it makes sense to withhold the fluid. Now if the pt. is suffering an acute case of heat illness and can protect airway, etc, and transport may not be initiated, it makes sense to rehydrate PO. The obvious example of this is a firefighter or tactical officer who has been working a scene pretty hard.

'zilla

[Eydawn]

Isn't that why a lot of rigs carry gatorade? For the FF's/Tactical/PD that get dehydrated at scenes? I know when I did one of my 3rd rides I was the gatorade flunky, set with cups and a huge gallon jug to get the FF's re-hydrated.... What about ice chips- it's such a small amount of water that it can't complicate things but still gives the patient a feeling of something wet in the mouth, thus making them feel better. Would that be enough fluid to mess up someone with restricted fluids/possibly on the way to the OR?

There was a study done a few years back on dogs and thirst, where they re-hydrated the pooches either IV or with a direct gastric tube, but the dogs went ahead and drank anyway because the psychological need of thirst had not been satisfied- wouldn't that hold true with the patient with the really dry mouth? You can pump their system full of fluids, but feeling something in your mouth curbs that thirst impulse...

Unless of course the patient was unable to protect their own airway, in which case a piece of ice might just not be the best thing, but then again, neither would water be at that point!

Eydawn

NREMT-B

[Dustdevil]

Just curious... does anybody's agency actually have a written policy or protocol that states all patients are to be NPO? Or is this simply being assumed by individual medics?

SPELL CHECKED: No errors found. 8)

[emt3225]

I agree. But only if the attending medic has both the education and common sense necessary to make that determination. Currently, very few do. It would require an entire new addition to the curriculum. And when considering additions to the curriculum, apparently this one has never come up. Or else somebody found it too insignificant to consider.

You have to remember, there are forces out there who fight every addition to the curriculum tooth and nail because they don't want their firefighters spending so long in school. Something has got to be pretty critically significant before it gets in.

I must ask you this Dust....Do you have the common sense or education to know if its ok to give someone water? You seem to think that most people wheter they are medics or emt's lack education... :roll:

[Dustdevil]

I must ask you this Dust....Do you have the common sense or education to know if its ok to give someone water?

Yes. But it darn sure didn't come from paramedic or EMT school. It came from nursing school and years of hospital practice.

SPELL CHECKED: No errors found. 8)