Field medications · Adult & pediatric guidance · ALS
Normal saline (0.9% sodium chloride)
Fluid resuscitation, pediatric bolus limits, and nebulized saline are different uses.
OCEMS source summary · Updated 2026-09-16
Check before giving
Reassess lung sounds and perfusion before more fluid. Avoid transferring sepsis fluid instructions into cardiogenic pulmonary edema.
PR-205 directs immediate base contact without fluids for pediatric cardiogenic shock with pulmonary edema.
Use in OCEMS
Used in multiple poor-perfusion/hypovolemia pathways and as a diluent or flush where a procedure specifies it.
Do not apply a universal fluid limit to every condition: hemorrhage/TBI, sepsis, cardiac, and pediatric pathways have different instructions.
Adult / adolescent
Indication / route
Dose & limits
Common medical resuscitation pattern
250 mL IV boluses, reassessing between doses, up to 1 L in the relevant medical standing order. Observe any clear-lung/no-CHF condition.
Traumatic hemorrhage / TBI
SO-T-005 gives separate ongoing-infusion and BP targets. Use that condition-specific pathway rather than assuming a universal 1 L ceiling.
Pediatric
Many pediatric orders specify 20 mL/kg IV/IO, maximum 250 mL per bolus, and base contact; up to 3 total boluses under the applicable standing order.
SO-P-080: if pressure does not improve after the first bolus, continue indicated fluid resuscitation and request a pediatric push-dose epinephrine order.
Croup-like barking cough in SO-P-035: 3 mL normal saline by continuous nebulization as tolerated. This is an inhalation dose, not a fluid-resuscitation dose.
20 mL/kg IV/IO, maximum 250 mL per bolus. SO-P-080 permits two repeats for three total boluses, with reassessment.
Make base contact. If BP does not improve after the first bolus, request the pediatric push-dose epinephrine order while continuing indicated fluid resuscitation.
This table is for the SO-P-080 shock bolus. Other indications have their own limits; PR-205 directs no fluid bolus when cardiogenic shock presents with pulmonary edema.
Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
Exact weight
Dose — IV/IO
3 kg
60 mL
4 kg
80 mL
5 kg
100 mL
6 kg
120 mL
8 kg
160 mL
10 kg
200 mL
12 kg
240 mL
15 kg
250 mL
20 kg
250 mL
25 kg
250 mL
30 kg
250 mL
35 kg
250 mL
40 kg
250 mL
45 kg
250 mL
50 kg
250 mL
60 kg
250 mL
Preparation & reassessment
Verify IV versus preservative-free nebulizer product and the intended route.
Record each bolus volume, cumulative volume, BP, respiratory findings, and response. Use the specific pediatric order for maximums and repeat count.