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 casualty’s forehead. Use a skin pencil, or another semipermanent marking for this purpose. You should also attach the empty syrette to the casualty’s 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 major reasons: 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 medications. 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 hemorrhage cases. 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 needle  cover. 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 following procedures: 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 13-14