FIELD REFERENCE
Full criteria & treatment guidance
Indications
- Volume/perfusion support under the applicable adult/pediatric order, or the specified flush/medication-preparation role.
Contraindications & local exclusions
- The cited 0.9% sodium chloride injection label lists none known. OCEMS fluid pathways still impose clear-lung/CHF, perfusion and reassessment limits; this is not unrestricted bolus authorization.
Precautions
- Fluid/solute overload, pulmonary edema, electrolyte disturbances and hypersensitivity are risks. Reassess lungs, BP and perfusion between boluses, especially with cardiac/renal disease.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
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.
Pediatric weight table — Poor perfusion / hypotension bolus
- SO-P-080 pediatric dose: 20 mL/kg IV/IO.
- 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.
VISUAL FIELD REFERENCE
Fluids: choose the condition before the volume
Adult & pediatric guidance · ALS
These are distinct pathways, not one universal bolus or maximum.
Common adult medical 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.
- 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.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. I-15 · I-20 · SO-M-055 · SO-T-005 · SO-P-080 · SO-P-035 · PR-205
UNDERSTAND THE CARE
Why saline has several roles on the same medication page
Resuscitation, line flushing, medication dilution and nebulization are different uses with different amounts and product requirements. Identify the intended role before preparing saline. An inhalation amount is not a vascular fluid bolus, and a flush instruction does not establish a resuscitation regimen.
Applying the guidance
For perfusion support, use the relevant adult or pediatric order and reassess before repeating. Record the individual bolus and cumulative amount with pressure, breathing, lung findings and clinical response. The child’s weight-based calculation still has its stated per-bolus cap and repeat conditions. Cardiogenic pulmonary edema requires its distinct pathway rather than automatic volume.
Reassess after each fluid bolus
Diagram text & teaching checkpoints
- Role
- Resuscitation, flush, dilution or nebulization.
- Product and route
- Use the intended preparation.
- Amount
- Condition-specific dose, cap and cumulative total.
- Response
- Perfusion AND respiratory findings.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
- I-15 — Adult / Adolescent Standing Order Drug Guide
- I-20 — Pediatric Medication Volume Dose by Weight
- SO-M-055 — Suspected Sepsis
- SO-T-005 — General Injury and Trauma - Adult / Adolescent
- SO-P-080 — Shock (Symptomatic Hypotension) - Pediatric
- SO-P-035 — Acute Respiratory Distress - Pediatric
- PR-205 — Preparation and Dosing of Push Dose Epinephrine - Pediatric
- Product label — SODIUM CHLORIDE injection, solution
- Name / formulation reference — Medication name and formulation terminology
Track delivered fluid rather than bags hung
For resuscitation, the useful medication record is the volume delivered, the time over which it was delivered and the response. “One bag started” does not establish an administered bolus or cumulative volume. Keep the clinical condition attached to the record because the allowed amount, reassessment requirements and next step differ across sepsis, trauma, cardiac and pediatric pathways.
For example, when a patient transfers between crews with fluid still running, report how much has actually infused and what happened to perfusion and lung findings after each increment. The incoming crew should not assume the container’s original size is the amount already delivered, or restart the cumulative count at handoff.
The fluid-reassessment diagram is the relevant companion for bolus decisions. A general mg-to-mL medication calculation is not required for a bolus already prescribed in mL or mL/kg. Saline used for a flush, dilution or nebulization remains a separate indication with its own preparation and instructions.
Source: Suspected Sepsis.