I had a question about the fluid overload contraindication for the IV and fluid therapy directive. I had a patient who was hypotensive with a history of CHF. They were hypotensive at 84/66, however had a mild increase in peripheral edema from their chronic swelling. Their chest sounded clear and they denied having any shortness of breath. Their work of breathing was laboured and they were satting between 90-93 on room air. They do have home o2 that they use intermittently when needed. Would this patient benefit from fluid bolus, or would they be contraindicated?

Q: pt has been dx by a doctor with pneumonia and the pt is now septic from not taking anti-biotics. Pt is hypotensive from sepsis and has the crackles in lungs from the pneumonia- not fluid overload from CHF. Is it okay to bolus this pt?

If I attend scene and the patient has already received care outside of the 911 system (i.e. fluid bolus with homecare or community paramedicine), and they are still hypotensive, can I provide further care via the ALS-PCS (i.e. fluid bolus for a hypotensive patient)? Would I only be able to give 20cc/kg IVF bolus including the fluid administered before my arrival?