Emergency Care In The Streets: Chapter 8 Medication Administration

Front 1

Percent of body weight that is water

Back 1

Total body water constitutes ~60%
-45% of body water is Intracellular
-13% of body water is Extracellular of that 10.5% is Interstitial and 4.5% is is Intrvascular.

Front 2

Solution

Back 2

A miture of two things a solvent and a solute.
-Solvent-The fluid that does the dissolving, or solution that contains the dissolved components.
-Solute-The dissolved particles contained in the solvent. Water serves as universal solvent, dissolving a variety of solutes, classified as electrolytes or nonelectrolytes.

Front 3

Compoents of sodium bicarbonate and its chemical sign:

Back 3

HCO3
Hydrogen
Carbon
3 Oxygen

Front 4

Diffusion

Back 4

A process in which molecules move from an area of higher concentration to an area of low concentration.
IE. Diffuse the party.

Front 5

The net effect of osmosis

Back 5

Low to high
The net effect is to equalize the solute concentration on both sides of the membrane.

Front 6

homeostasis

Back 6

The internal enviroments' resistance to change, maintaining a balance.

Front 7

S & S of dehydration and causes

Back 7

Inadequate total systemic fluid volume.
S&S: Dec LOC, postural hypotension, tachypnea, dry mucous membranes, tachycardia, poor skin turgor, flushed skin.

Causes: Diarrhea, vomiting, GI Drainage, hemorrhage, insufficient food or water intake.

Front 8

Characteristics and causes of overhydration

Back 8

The body's total systemic fluid volume increases.
S&S: SOA, puffy eyes, edema, polyuria, moist crackles (rales), acute gain weight.

Causes:Unmonitored IVs, kidney failure, prolonged hypoventilation.

Front 9

The cardinal sign of overhydration is...

Back 9

edema

Front 10

Osmolarity and isotonic solutions

Back 10

Have almost the same osmolarity concentration of sodium, as serum and other body fluids.
NS, LR, D5W

Front 11

Components of NS

Back 11

Isotonic solution
0.9% of sodium chloride

Front 12

Considerations of isotonic solution administration in CHF pts

Back 12

CHF pts are at higher risk for fluid overloading.
The extra fluid increases proload, which in turn increases the workload of the heart, creating fluid backup in the lungs.

Front 13

Characteristics of colloid solutions

Back 13

High osmolarity, contain molecules (usually proteins) which are too large to pass out of capillary membranes, and therefore remain in vascular compartment. They draw fluid from the intersitial and intracellular compartments into the vascular compartments. Works well to reduce edema.

Front 14

Types of peripheral veins

Back 14

Hand, arm, EJ, lower ext

Front 15

Questions to ask prior to IV solution determination

Back 15

-Is the pt critical?
-Is the pt stable?
-Does the pt need fluid replacement?
-Will the pt need medication?

Front 16

Most common IV solution in EMS

Back 16

NS

Front 17

Sterile technique with the IV bag

Back 17

-While in plastic bag it remains sterile until open or expiration date
-Once removed from bag it must be used within 24hrs
-Removable pigtail protects sterile access port

Front 18

Purpose of buretrol

Back 18

Also called Volutrol, purpoes is to control fluid for pts, usually used for peds or certain geriatric pts.
Allows you to fill a 100 or 200 mL calibrated drip chamber with a specific amount of fluid.
60 Drip/Micro drip set

Front 19

Vein determination process

Back 19

-Strightest appearance
-Firm, round, springy when palpated
-Avoid joints
-Avoid edema
-Avoid same side as dialysis fistula or same side as mastectory was done.
-Start distal work proximal

Front 20

IV cannulation process and pitfalls

Back 20

Large veins may roll use traction, stabilize vein

Front 21

What "track marks" signify

Back 21

Usually sign of sclerosis (hardening or thickening of tissue) by frequent cannulation or puncture of the vein, IE. Drug user/abusers.

Front 22

Catheter selection

Back 22

-Should reflect the purpose of the IV
-Age of pt
-Location of IV
-Usually adult hand 18g or 20g
Adult AC can handle 14g or 16g

Front 23

Saline lock usage in prehospital setting

Back 23

Way to maintain IV site without running fluid. Also known as intermittent (INT) sites because they eliminate the need to reestablish IV each time the pt needs fluid or meds.

Front 24

IV Bag change process

Back 24

Do not allow an IV bag to become completely depleted of fluid, change it at ~25mL of fluid is left. Remember replacing the bag is a sterile process.

Front 25

Steps in discontinuing an IV

Back 25

-Shut off flow
-Remove tape
-Fold 4x4 and place over site
-Pull cath out while applying pressure

Front 26

EJ Cannulation risks

Back 26

The 3 main risk are:
1) Puncture to carotid artery
2) Rapidly expanding hematoma
3) Air embolism

Front 27

Problems solving for the IV bag that won't flow

Back 27

-Check IV fluid
-Check the administration set
-Check the height of bag
-Check the type of catheter used
-Check constricting band

Front 28

Signs of infiltration

Back 28

Escape of fluid into surrounding tissue, causing localize edema, continued IV flow after occlusion of the vein, and pt complains of tightness and pain around IV site.

Front 29

Causes of thrombophlebitis

Back 29

Inflammation of the vein
-Venous cannulation
-Lapses in aseptic technique
-Long term IV therapy
-IV drug abusers
-Excess motion of IV needle of catheter

Front 30

S&S of hematoma

Back 30

Accumulation of blood in the tissue surrounding an IV site, often result of vein perforation or improper removal of IV.
S&S include pooling blood around site, tenderness and pain.

Front 31

Possible complication of an IV near a joint

Back 31

Increase risk of perforation of tendon, ligaments, and nerves. S&S will be sudden and sever pain, numbness and tingling afterward.

Front 32

Common causes of circulatory overload

Back 32

Failure to set drip rate

Front 33

S&S of circulatory overload

Back 33

-Dyspnea
-JVD
-HTN
-Crackes (rales) in breath sounds

Front 34

Primary cause of vasovagal reaction

Back 34

Anxiety
Causes vaso dilation, leading to drop BP, and collapse.

Front 35

S&S of catheter shear

Back 35

-Sudden dyspnea
-Diminsh breath sounds
-Same as air embolus

Front 36

Metric standard calculations
lb to kg and kg to lb

Back 36

2.2lb=1kg
kg to lb is kg x 2.2=lb

lb to kg 2 options
Option 1: Divide the pt's weight in lbs by 2.2
Ex:170lb/2.2=77.27kg=~77kg
Option 2: Gives ~ by dividing the pt's weight in lbs by 2 and subtract 10% of that #
Ex:120lb/2=60
60-6=54kg

Front 37

What a paramedic should do if they receive inappropriate med order?

Back 37

Have them repeat order.
Do no harm. Make sure medical control understands. Communicate.

Front 38

Medication administration process and considerations

Back 38

6 rights
-Rt Pt
-Rt drug
-Rt dose
-Rt route
-Rt time
-Rt documentation

Front 39

Drug contraindication considerations

Back 39

When not to give the med

Front 40

Medical asepsis

Back 40

The practice of preventing contamination of the pt by using aseptic technique. Clean technique. Handwashing, wearing gloves, and keeping equipment clean.

Front 41

asepsis

Back 41

The state of being free of pthogenic organisms.

Front 42

"medically clean"

Back 42

Cleaned as possible in the field.

Front 43

Antiseptics vs. disinfectants

Back 43

-Antiseptics used on pts before invasive procedure to clean the are, destroy pathogens, and are not toxic to tissue. IE alcohol and iodine
-Disinfectants-Never to used on pt but to clean equipment as they are toxic to living tissue.

Front 44

Components of minimum BSI

Back 44

Wearing gloves and eye protection

Front 45

Characteristics of sharps containers

Back 45

-Readily accessible
-At least 2 in back of ambulance
-Sharp shuttle ava.

Front 46

Types of drugs administered via rectal route

Back 46

Diazepam (Valium)
Certain antimetic meds (promethazine [Phenergan])
Suppository a drug mixed in firm in firm base that melts at body temp, shaped to fit.

Front 47

entral route

Back 47

Any route in which medication is absorb through some portion of the GI tract. IE. oral, gastric tube, and rectal administration.

Front 48

Enteral vs parenteral medication administration

Back 48

Parenteral any route other than GI tract. IE intradermal, SC, IM, IV, IO, etc. They are absorb into the central circulation more quickly and at more predictable rate.

Front 49

The most common medication route in prehospital setting

Back 49

IV

Front 50

Ampule medication extraction process

Back 50

1) 6 rights
2) Shake or tap med to base of ampule
3) Using 4x4 or alcohol pad, grip the neck of ampule and snap off. Stem to sharps.
4) Filter needle into ampule without touching sides of ampule, draw soulution, dispose of ampule to sharps
5) Release air bubbles.
6) Recap needle than change out for new needle

Front 51

Benefits to using prefilled syringes

Back 51

Ease of use as they are much quicker and easy to use.

Front 52

Where the intradermal medication route is typically used?

Back 52

Physician's office or hospital setting used to test for TB

Front 53

Max amount of fluid that can be used in SC

Back 53

1mL or less

Front 54

Steps of the IM administer

Back 54

up to 5mL
BSI
Hx: Allergies etc
Need
Prep equip
Clean site
Stretch skin, advist pt, insert at 90 degress.
Aspirate for blood, blood stop and start over
No blood inject, dispose of sharp
Rub area site
monitor pt

Front 55

IV med bolus considerations

Back 55

No room for error as it is going directly into circulatory system bypassing most barriers to drug absorption.

Front 56

Considerations after administering a medication

Back 56

Monitor pt for reactions

Front 57

Considerations of premixed maintenance infusions

Back 57

IE Lidocaine, dopamine, Epi
All of these meds require careful titration to achieve desire effect.

Front 58

Types of med given via the transdermal route

Back 58

Medication apply topically.
Nitro, estrogen, nicotine, and analgesic patches are ex. along with creams and paste.

Front 59

Most common inhaled medication

Back 59

oxygen

Front 60

Fastest to slowest med routes

Back 60

Intracardiac 15 seconds
IV 30 to 60 seconds
IO 1 minute
Endotracheal 2-3 minutes
Inhaled 2-3 minutes
Sublingual 3-5 minutes
IM 10-20 minutes
SC 15-30 minutes
Rectal 5-30 minutes
Oral 30-90 minutes
Topical Hours to days

Front 61

Steps to control a rolling vein

Back 61

distal traction and stabilize

Front 62

Treatment options of "syncope after seeing the needle" pt

Back 62

1) Shock position
2) High-flow O2
3) Monitor VS
4) Establish IV in case fluid resuscitation is needed

Front 63

Sharps disposal procedure

Back 63

ASAP, Do not pass sharps

Front 64

Clinical indicators of pyrogenic reaction

Back 64

Pyrogens are foreign proteins capable of producing fever. Their presence in IV set will induce pyrogenic reaction. Characterize by an abrupt temp increase as high as 106 F, with severe N/V, and occasional vascular collaspe, along with s/s of shock. Begins within 30mins of start of infusion.