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About Fluids



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The Digital Learning Space


Assess NeedWhat to GiveRecent Evidence

Where to Start

assess Need

Whether to or not to give fluids is more nuanced than it may appear—the three questions you need to ask to make that assessment are:

  • Are they hypotensive now (before intubation)?
  • What is their current volume status?
  • What is their current cardiac function?
  • Start with 1-2 Liters of NS or LR
  • Goal of MAP >70 mmHg
  • Prior to intubation.

News Update: normal saline is just fine (didn’t we already know that?) Don’t let anyone tell you otherwise.

What to Give

Yes its okay to give normal saline

Balanced fluids or normal saline. We can finally end this debate. The BaSICS trial can put your mind at rest on this one. This BOTTOM LINE of a great review from Justing Morgenstern sums it up.

“This is the best and largest study of normal saline and balanced IV fluids to date, and it is pretty clear that normal saline is as safe as the balanced fluid. (Whether providing either IV fluid to these patients is beneficial is a completely different question.) Continue to use whatever is easiest for your team. I still almost always use saline myself.”

Morgenstern, J. The BaSICS trial: Normal saline has been fine all along, First10EM, August 11, 2021. Available at:

The Latest Evidence

does a fluid bolus prevent hypotension

What is the evidence for this practice? Recent studies put the value of fluids in to question in the peri-intubation period. We bottom line it for you below and give you access to the deeper dive on RebelEM.


Clinical Take Home Point: “Putting all the evidence together (PrePARE and PrePARE II), the administration of 500mLs of fluid prior to intubation does not seem to decrease the incidence of cardiovascular collapse in critically ill adult patients undergoing tracheal intubation and should not be routine practice. “Resuscitate before you intubate” is a nuanced procedure that requires focused interventions based on the patient’s pathophysiology”. – RebelEM. Another great way to build your learning network đź’Ş

  1. Russell DW et al. Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial. JAMA 2022. PMID: 35707974 [Access on Read by QxMD]
  2. Janz DR et al. PrePARE Investigators; Pragmatic Critical Care Research Group. Effect of Fluid Bolus on Cardiovascular Collapse Among Critically Ill Adults Undergoing Tracheal Intubation (PrePARE): A Randomised Controlled Trial. Lancet Respir Med 2019 PMID: 31585796

Procedure Video

Spike a Bag

Have you ever learned how to spike a bag of fluids? It seems simple enough, but you should learn how to do it correctly. Watch this video and then head to the practice station below.

The Physical Learning Space

Procedures, Skills Challenges, Expert Coaching

HANDS-ON training

Remember, if you’re in one of our pop-up learning spaces or a PAC Live event, find this icon and use the multimedia tools for hands-on guided practice.

  1. Look for this icon.
  2. Snap the QR code.
  3. Begin your hands-on practice.
  4. Get feedback on your skills.

Don’t forget to ask our faculty coaches for real-time expert feedback and earn points!

Earn Points

Keep yourself on track and get credit for completion using this guide.

  1. Open the guide to a tab on your browser.
  2. Visit each poster & review the content.
  3. Complete any challenges to earn points.

What’s Next

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Congratulations! You’ve completed this section of the learning space. Don’t forget to collect all the available points before moving on to the next poster to explore all the interactive and hands-on learning opportunities. 

If you can’t be with us in person, you can still enjoy the online version of this learning space by using the link below.

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