I was hoping to get clarification on the appropriate fluid bolus amounts for a patient suspected to be in cardiogenic shock but not having an identified STEMI. The patient I attended to in this call was found to be in rapid atrial fibrillation and hypotensive, along with appearing pale and having complaints of dizziness. From the 12-lead ECG we did not identify any STEMI. The patient did complain of nausea/vomiting earlier in the day, and also did have a fall approx 1 week earlier where pt fell on his left side. There were multiple factors at play here which may have contributed to this patient’s complaints of dizziness and hypotension. In hindsight, I am now suspicious that this patient was in cardiogenic shock. In the cardiogenic shock auxiliary directive, it states that the patient needs to have a STEMI positive 12-lead ECG and be in cardiogenic shock to be administered a halved saline fluid bolus (10mL/kg). However, in the IV fluid auxiliary directive, it only requires the patient to be in cardiogenic shock to have the halved saline fluid bolus administered. In hindsight, I believe I should have administered approx 500ml of saline instead of the 1000ml I did administer.

Would SWORBHP be ok with ACP paramedics utilizing the 4-2-1 rule for fluid maintenance rates in paediatrics. Especially, with the high incidence of RSV in the community compounded with sick kids who aren’t taking in as much fluids and may be fluid depleted. Their fast respiratory rates and poor feedings, fever etc increases the insensible fluid loss. I can appreciate the current model, for fluid boluses utilizing the 70 mmHg + (2 x age in years). However, at this point they are decompensating rapidly with the hypotension and progressing to pre-arrest (with signs of delayed peripheral and central cap refill, looks sick as per PAT etc). Is the current protocol 15 ml/hr for