Page 188 - 2022 Ranger Medic Handbook

SODIUM CHLORIDE, 0.9% (NORMAL SALINE)
Class: Plasma volume expander – crystalloid; isotonic salt solution
–
+
Action: Each 1mL contains 9g sodium chloride (Na 154mEq/L; Cl 154mEq/L); pH 5.7; expands circulating volume
by approximating sodium content of the blood; but it remains in the intravascular space for only a very limited time as
it diffuses rapidly throughout the extracellular space
Dose: 500–1,000mL IV; 5–50mL IV for medication dilution or as flush
Indications: For fluid replacement and plasma volume expansion when blood or plasma is not available, and for
adjunctive treatment of shock and hypovolemic states caused by hemorrhage, burns, surgery, sepsis, trauma, dehy-
dration, or heat injury; also used for dilution of medications, as IV flush agent, for saline locks, and irrigation of eyes
and wounds
Contraindications: Congestive heart failure (CHF)
Adverse/Side-effects: Fluid overload, CHF, edema, electrolyte imbalance, hyperchloremic metabolic acidosis,
hypertension
Interactions: No clinically significant interactions established
SECTION 4

SODIUM CHLORIDE, 3% or 23.4% (HYPERTONIC SALINE) *
Class: Plasma volume expander – crystalloid; hypertonic salt solution.
Action: Each 100mL of 3% sodium chloride injection USP contains: sodium chloride USP 3g; each 10mL of 23.4%
sodium chloride injection USP contains: sodium chloride USP 2.34g
Dose: 250mL IV bolus of 3% or 30mL bullet of 23.4%
Indications: For AMS IAW Hyperthermia Management Protocol and concern for emergent hyponatemia; for TBI IAW
Head Injury Management Protocol
Contraindications: CHF; do not use with blood or blood products, presence of normal or elevated plasma electrolyte
concentrations
Adverse/Side-effects: Fluid overload, CHF, edema, electrolyte imbalance, hypertension
Interactions: None

SUFENTANIL (DSUVIA)
Class: CNS agent – potent narcotic (opiate) agonist
Action: Action similar to morphine with more rapid and less prolonged analgesia and sedation, but less emetic effect
Dose: 30mcg sublingual ODT q1hr prn pain
Onset/Peak/Duration: Onset 15 minutes; Peak 30–40 minutes; Duration 3 hours
Indications: For moderate to severe pain management
Contraindications: Significant respiratory depression; known hypersensitivity to sufentanil; pregnancy category may
use during pregnancy and consider alternative while breastfeeding
Adverse/Side-effects: Nausea, headache, vomiting, dizziness, hypotension, severe respiratory depression
Interactions: Macrolides, azole-antifungals, rifampin, phenytoin, alcohol, benzodiazepines, opioids, MAOIs, SSRIs,
TCAs
Mission Impact: GROUNDING medication for personnel on flight status

174 SECTION 4 RANGER MEDIC PHARMACOLOGY & FORMULARY