DEHYDRATION

Originated 01-25-2010

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DESIGNATION OF CONDITION
The patient has experienced an abnormal loss of body fluids. Diarrhea, vomiting, profuse sweating, hyperthermia, fever, pharmacological causes, or a decrease in fluid intake may cause this condition. Signs and symptoms may include any or all of the following: lethargy, dry skin and mucous membranes, disoriented, weakness, tachycardia, hypotension, weak or absent radial pulses, cool and clammy skin, diaphoresis, pallor, nausea and vomiting, rapid and shallow respiration, elevated core body temperature. In the pediatric patient: sunken fontanels, fever, crying without tears, diminished number of wet diapers, recent history of diarrhea, lethargy.

EMPHASIS ON PATIENT CARE
Maintain ABCs. Provide fluid replacement,  cooling , removal from heat source, and airway management.

FIRST RESPONDER AND BASIC PRE-HOSPITAL MANAGEMENT

1. Assess airway, breathing and circulation and manage as indicated. Use humidified O2.
2. Transport the patient as soon as possible to the nearest medical facility.
3. Obtain focused H&P - History, physical exam, vital signs, including BGL.
4. Treat underlying cause(s) (See Specific Treatment Protocols).
5. Consider use of oral hydration fluids if the patient is conscious and able to self-protect the airway.
6. Cool by placing patient in a sheltered environment, remove or loosen any restrictive clothing, mist skin with tepid water while fanning victim. Truncal cold packs may be used, but are less effective than evaporation. Discontinue cooling if shivering occurs.

INTERMEDIATE and PARAMEDIC PRE-HOSPITAL MANAGEMENT

7. Initiate one or two large bore IVs of an isotonic solution enroute. Bolus the patient with 20cc/kg and infuse at a flow rate to maintain adequate vital signs, including systolic BP>90 mmHg.
8. Use a Buretrol IV set on pediatric patients and bolus at 20 cc/kg, repeating as necessary. Consider intraosseous access if the patient’s condition warrants.