Intravenous Access

Tissue oxygenation also requires restoration of circulating blood volume, and it is routine to place at least two large-bore intravenous lines for infusion of crystalloid and potentially blood. A practical limitation during fluid resuscitation is sometimes the size of the intravenous access, which limits the rate of infusion ( Table.27-2). The largest-bore catheter possible should be used in patients who may require aggressive fluid administration. All patients should be placed on a continuous cardiac monitor and pulse oximeter. As the intravenous lines are placed, initial blood samples should be drawn for type and cross matching, coagulation studies [prothrombin time (PT), partial thromboplastin time (PTT), platelet count] and a baseline complete blood count (CBC). All women of childbearing age need a pregnancy test. An immediate serum glucose assessment is critical in the patient with a depressed level of consciousness. A baseline metabolic assessment requires more extensive laboratory study, including serum electrolytes, blood urea nitrogen (BUN), creatinine, and liver function tests. An arterial blood gas (ABG) provides crucial information about the patient's acid-base, oxygenation, and ventilatory status and, if available on the blood gas analyzer, data regarding the patient's hematocrit and bicarbonate level. An initial electrocardiogram (ECG) is also indicated in adult patients. All patients should have a Foley catheter placed, as urine output is believed to reflect underlying renal perfusion.

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