4. Grasp the wire loop at the end of the needle and
push down on the loop until it is stopped by the guard.
This will pierce the metal seal on the collapsible tube.
5. Pull on the wire loop and withdraw the wire
completely from the needle. Throw the wire away. Do
not touch the needle.
6. Thrust the full length of the needle straight
through the skin at the injection site.
7. Inject the morphine by slowly squeezing the
collapsible tube. Start squeezing at the end of the tube
and work your way down toward the needle. Once all
the morphine has been injected, withdraw the needle
and massage the injection site for a few minutes to help
circulate the morphine.
8. Record your treatment. Medical personnel who
later provide treatment for the casualty must know when
the morphine was administered. Record the treatment on
the U.S. Field Medical Card (discussed later), and write
the letter M and the time of the injection (e.g., M 0830),
on the casualtys forehead. Use a skin pencil, or another
semipermanent marking for this purpose. You should
also attach the empty syrette to the casualtys shirt collar
or to some other conspicuous part of the clothing.
INTRAVENOUS INFUSION OF FLUIDS.
Parenteral therapy is the nonoral (not by mouth)
administration of fluids (e.g., intravenous infusion of
fluids). This therapy may be required when a casualty
loses a large quantity of body fluids as a result of injury
and shock. To halt and reverse shock, lost fluids must
be replaced. If a casualty cannot take fluids by mouth,
or is unable to take enough by mouth, a medical or
dental officer may administer fluids by other means.
Ordinarily, you will not be involved with the
intravenous administration of fluids, but in a mass
casualty situation, you may be required to assemble,
insert, and maintain intravenous therapy equipment
either under the supervision of a medical or dental
officer, or on your own.
Intravenous therapy, commonly called an IV, refers
to the administration of fluids, drugs, or blood directly
into the circulatory system by way of a vein. When
whole blood is administered, the technique is called
transfusion. When sterile fluids (blood volume expanders)
are administered, the technique is called infusion
Intravenous infusion is used in the field for three
To add fluid volume to the circulatory system
when there is an imbalance or depletion of
normal body fluids, as in hemorrhage or burns.
To establish and maintain life support for a
casualty whose condition is questionable, and it
is felt that the person might deteriorate.
To provide an access for the administration of
There are basically four types of fluids used for
infusion in the field:
D5W, 5 percent dextrose and sterile water, given
in cases where the IV is used to establish a
lifeline or a medication route.
N.S., or normal saline, which is 0.09 percent
sodium chloride in sterile water, and used for
irrigation of wounds.
Lactated Ringers, a solution of electrolytes
isotonic (having equal pressure as blood, so that
it will not destroy red blood cells when injected
into the blood stream) is used for trauma cases,
burns, and hemorrhagic shock.
Dextran, a blood plasma substitute containing
large molecules of glucose, used in serious
The equipment used is in sterile disposable sets, as
shown in figure 13-12. The equipment set contains:
1. The solution to be infused.
2. The IV itself, consisting of the piercing device
cover, piercing device, airway valve, drip
chamber, roller clamp, tubing, needle, and
3. Some sets may contain auxiliary equipment
such as an arm board, antiseptic solution, tape to
secure the IV tubing, a tourniquet, and gauze
pads to cover the insertion site.
Preparing the Solution.-The medical officer
will choose the solution and needle for the infusion
procedure. The solution comes in a plastic bag that
must be connected to the sterile, disposable infusion
set. Connect the bag to the infusion set using the
1. Open the infusion set, close the roller clamp on
the tubing, and put the infusion set aside.
2. Remove the solution bag from the wrapper.
Ensure that the expiration date has not passed. Check
the solution by holding the bag up to the light. The
solution should be clear. The solution cannot be used if
it is cloudy or if it contains any sediment or mold.
Squeeze the bag and check for small leaks. If there is