Intravenous Flashcards
Identify factors that affect flow rate:
Constricting band still in place and swelling at the site cause by infiltration. Tip of the catheter against a wall or valve. Flow regulator closed or clamps in place. Bag height as opposed site height.
Purpose and indication for peripheral IV coagulation:
Fluid and blood replacement, drug administration, obtaining blood specimens for laboratory analysis
Complications of peripheral IV cannulation:
Infection at the site, superficial thrombophlebitis, IV site may leak interstitially.
Identify potential complications of intraosseous needle insertion:
Fracture, infiltration, growth plate damage, complete insertion, pulmonary embolisms
Discuss the principles and techniques for applying added pressure to an invasion line:
Used to pressurize sterile parenteral fluids to provide for rapid infusion into patients suffering from hypovolemia /complications
Discuss purpose of and indication for pressure infusions:
Hypovolemia or complications which require rapid fluid administration, tech: use a pressure bag
What is a volume expander (colloid, non-crystalloid)
Colloid – intravenous solutions containing large proteins that cannot pass through capillary membranes; colloids have osmotic properties that pull water into circulatory system.
Reasons for administering volume expanders:
Hypovolemia, IV blood, dehydration
Equipment needed for volume expanders:
Water, solution, tubing
Components of blood and description:
Plasma: liquid part of blood 92% water, 6-7% water, and small portion consists of proteins, electrolytes, lipids, enzymes, glucose, clotting factors.
Formed elements – red blood cells, white blood cells, platelets
Blood types
O+, O-, A+, A-, AB+, B+, B-, AB-
Blood products derived from blood:
Red Blood cells, platelets, plasma
Precautions that should be used when handling blood:
BSI
Potential complications of blood transfusions:
Discrepancy between blood types to the patient/transfusion blood
What is defibrillation?
The process of passing en electric current through a fibrillating heart to depolarize a critical mass of myocardial cells. This allows them to depolarize uniformly resulting in an organized rhythm.
What is the purpose of automatic external defibrillation?
To stop the electrical activity in hopes it restarts in an organized rhythm
Indications for AED?
Pulse less, no breathing, no circulation
Types of automatic external defibrillation:
Fully automatic – prompts user
Semi automatic – has ECG capabilities for health care providers Biphasic – travels in two directions
Monophasic – travels in one direction
Complications of AED:
Pads not sticking, wet environment, shocking the heart into asystole, etc.
Difference between AED and manual defibrillation:
Manual has more options and can do ECG’s. AED is simplified and prompts the lowest first aid provider to be able to use an AED.
Purpose of manual defibrillation:
to start heart in organized rhythm
Indications for manual defibrillation:
Health care provider is trained to use it on a indicated patient, same as AED
. Various types of manual defibrillators:
MR-X, Lifepak 12, Lifepack 15, Zoll
Complications of manual defibrillation:
Lack of education, not using properly, over stimulating/ under stimulating the heart, ECG interpretation errors
Identify where manual defibrillation is required:
When a trained person is capable and able to use a manual defibrillator.
What is cardioversion?
The passage of an electric current through the heart during a specific part of the cardiac cycle to terminate certain kinds of dysrhythmia
Equipment required for cardio version:
Sedation, Synchronizer, Electrodes
Complications of cardioversion:
Blood clots, abnormal heart rhythm, skin burns
What is transcutaneous pacing?
Temporary means of pacing a patient’s heart during a medical emergency. Its accomplished by delivering pulses of electric current through the patient’s chest, which stimulates the heart
Equipment needed for transcutaneous pacing:
Defibrillation with TCP capabilities, sedation
Complications associated with transcutaneous pacing:
Discomfort, tachycardia
Purpose of a urinary catheter?
Used to drain the bladder, recommended: urinary incontinence, urinary retention, surgery, and other medical substances
Equipment required for urinary catheterization:
Condom catheter, Indwelling catheter, intermittent (short-term) catheter
How can catheter size affect the patient?
Leaks, pain, discomfort, infection risk
Relation between urinary output and patient condition:
Increased, decreased or changes in urinary output. It can indicate problems with a catheter or kidney function.
Potential complications of urinary catheterization:
Infection, leaks, allergy to latex, blood in the urine, kidney damage, UTI, urethral infection, bladder stones
How to drain and measure urine output:
Empty drainage bag from the part at bottom of the bag to measure urine output, one can the guide on the bag or empty the contents of the bag into a measuring cup.
Purpose of ostomy bag:
An ostomy is a surgical opening in the body for the discharge of bodily wastes
Equipment for ostomy draining
Clean and deodorize the drainage bag by filling it with a mixture of vinegar and water or chlorine bleach, let bag sock for 20 minutes then hang with valve open to dry.
Identify site of ostomy and relate to patient condition:
Large intestines (colon), descending colon, transverse or sigmoid colon. Small intestine (ileum)
Explain purpose of non-catheter urinary drainage
Less invasive and only used for short term usage, less infection risk and less discomfort to the patient
Purpose of a chest tube:
To drain air, blood or infection from the pleural space
Indications for a chest tube:
Pneumothorax, malignant pleural effusion, empyema and complicated pneumonia, post-op thoracostomy, esophagectomy, cardiac surgery
Indications for a thoracostomy:
Open or closed Pneumothorax, simple or tension Pneumothorax, hemothrorax, empyema, pleural effusion, Patients with chest wall, penetrating injury who are or about to be intubated, Considered for those about to undergo air transport who are at risk for Pneumothorax
quipment needed for thoracostomy:
Chest tube drainage device with water seal, suction, tubing, surgical marker, needle, lidocaine, Kelly clamps, needle cleaner, gauze, adhesive seal, chest tubes (man, woman, child, infant, neonate)
Indications for oral and nasal gastric intubation:
Patients unable to swallow or eat or receive nutrition
Identify components of a closed chest tube system:
Collection chamber, water seal chamber, wet suction control, dry suction, one way valve, gravity drainage
Indications for urinary catheterization:
Urinary incontinence, urinary retention problems, surgery on the prostate/genitals, MS, dementia
Equipment needed for urinary catheterization:
Catheter (appropriate size), sterile gloves, cleansing solution, syringe, lubricant, collection bag, tubing
Explain the difference between male and female urine catheterization:
Length of the catheter, procedure is slightly different i.e. insertion technique. Males there should be slight traction on the penis when inserting
Identify the purpose for dressing a burn:
To prevent infection and further contamination
Types of burn dressings:
Dry sterile dressings, non-adherent dressings, sterile wet dressing
Purpose of eye dressings:
Both eyes are dressed to prevent the eyes from moving (sympathetic motion). If eye injury is an open wound consider using a sterile dressing soaked in saline –> reduce pain, prevent fluid loss
Purpose and indication for dressing a penetrating wound:
Only remove impaled object if it interferes with the airway or CPR, purpose is to stabilize the object and prevent further bleeding.
Types of penetrating wound dressings:
3 sided occlusive dressing -> open Pneumothorax, sterile gauze dressings, VAC dressing
Method for local cold injury assessment:
Appearance, pain, sensation, swelling, palpation
Types of tissue damage that may result from local cold injury:
Involving only epidermal tissue: redness, blanching, decreased sensation, “frostnip”. Involving epidermal and subcutaneous tissue: white, hard, loss of sensation
Wound healing stages:
Hemostasis: body’s ability to stop bleeding. Inflammation: local cellular/biochemical changes. Epithelialization: cells migrate over surface of wound. Neovascularization: new growth of capillaries. Collagen synthesis: fibroblasts synthesize collagen, rebuild damaged tissues
Explain the process of suturing/stapling and removal:
Inspect wound for infection, approximation, clean wound, use forceps to loosen the stitches, cut every other suture OR remove every other staple with staple removal tool until all sutures/staples are removed, clean wound again, apply sterile strips if the wound needs more time to heal and close
Define Aseptic:
Free of pathogens
Define sterile:
Free from all forms of life
Identify signs and symptoms of possible fractures to the appendicular skeleton:
Pain, swelling, deformity, instability, crepitus, applicable MOI pain, pallor, paralysis, pressure, pulses
Evaluate commercially manufactured splints:
Rigid splint, formable splints, soft splints, traction splint, pillow splint
Identify signs and symptoms of possible fracture to the axial skeleton:
Applicable MOI, paralysis of extremities, pain with and without movement, spinal deformity, spinal tenderness, impaired breathing, posturing, incontinence, nerve impairment
Describe the relationship between kinematics to potential spinal injury:
Moving the patient with a spinal injury could make their injuries worse if they are not properly immobilized i.e. rapid extraction
Types of immobilization devices:
Cervical collar, spine board, head blocks, KED (vest type immobilization device)
Define closed reduction:
Returning of displaced bone ends to their proper anatomical position (without making an incision)
Indications for fracture and dislocation reduction:
Attempt reduction of a dislocation only when you are sure the injury is a dislocation, when you expect long transport time, significant neuro. deficit, only when there are no other serious injuries
Identify sources of medications:
Plants, animals, minerals, laboratory (synthetic) -fox glove (plant)
- insulin (animal ->cow, pig)
- calcium chloride (mineral)
Describe the mechanism of entry:
Absorption: a drug must be absorbed into the bloodstream in order to take effect, therefore this is the first stop when drugs are taken by mouth or injected outside bloodstream
Site of action: the place in the body where a drug exerts its effects
Metabolism: the body’s breaking down of chemicals (drugs) into different chemicals for use Elimination: most drugs are excreted through urine, some through feces and expired air
Medication calculations and formulas:
Volume to be administered = volume on hand x desired dose / Dose on hand Gtts/min = volume on hand x drip factor x desired dose / Dosage on hand
Explain factors that affect the absorption, distribution and elimination of a medication:
Age – liver and kidney function
Body mass – more body mass = more fluid to dilute drug, patient environment
Time of administration – immediately after eating will slow down, pathological status, genetic factors, psychological factors
Identify drug classifications:
A drug class is a group of medications that may work in the same way , have a similar chemical structure or are used to treat the same health condition. Drugs to affect: nervous system, cardiovascular system, respiratory system, gastrointestinal system, eyes, ears, endocrine system, to treat cancer, infectious diseases and inflammation, skin, supplement the diet, treat poisoning/overdose
Identify chemical, generic, trade, and official names for all medications:
Chemical name – name of a chemical compound that shows the names of each of its elements or sub compounds.
Generic name – the official non-proprietary name of a drug
Trade name – the commercial, trademark name of a drug, Official name
List signs, symptoms and side-effects of iatrogenic overdose:
Allergic reaction – idiosyncrasy, tolerance, cross-tolerance, tachyphylaxis, cumulative effect, drug dependence, drug interaction, drug antagonism, summation, synergism, potentiation, interference
Explain the 5 rights of medication administration:
Right medication, right dose, right time, right route, right patient, right documentation
List medication administration routes:
Enteral routes – oral, nasogastric tube, sublingual, buccal, rectal.
Parenteral routes – intravenous, endotracheal, intraosseous, umbilical, intramuscular, subcutaneous, inhalation/nebulised, topical, transdermal, nasal
Describe how medication administration protocols are applied to specific patient presentation:
The paramedic’s knowledge of drug indications, dosages and routes of administration is of importance. If ever in doubt the use of dosages of medications contact OCMC.
Explain the role of the paramedic in medication administration:
Paramedics do not operate autonomously. You operate ender the license of a medical director. It is your responsibility to know the meds/routes/dose for your patients
Steps to medication administration:
Identify cause, assess rights, draw up appropriate dose, assess indications/contraindications, administer syringe with 24-26g needle 1-2.5 cm long
Identify medical conditions and indications for subcutaneous administration of a medication:
Only 1mL can be injected. SQ has even fewer blood vessels and promotes slow, sustained absorption
List approved drugs for subcutaneous medication administration:
Glucagon, insulin, growth hormones, epinephrine, morphine, hydromorphine, vaccines and allergy shots
List appropriate injection sites for SQ med admin:
Upper arms, thighs, stomach
List benefits to SC medication administration:
Used on patients who can no longer tolerate therapy, increased patient comfort and the admin of excessive number of tablets,slower rate of absorption, convenient
Identify medical conditions that indicate for IM medication administration:
Hypoglycemic, overdose, etc
Distinguish approved drugs that can be administered IM:
Epinephrine, glucagon, codeine, morphine, penicillin, vitamin B12, ketamine
List appropriate medical admin sites for IM:
Mid deltoid, dorsal gluteal, rectus femoris
Discuss the benefits of IM med administration:
Depending on chemical property may be absorbed rapidly or gradually. Predictable absorption rates
Explain steps and procedures for IM medication administration:
Rights, site, clean, inject, aspirate, inject slowly
Describe medication and patient conditions that indicate IV med admin:
Hypoglycemia, pain, dehydration, cardiac/respiratory issues
List approved mediations for IV medication administration:
DSO, diazepam, proposol, morphine, CPI
Explain the benefits to IV medication administration:
Direct access to veins, direct med admin
List medical conditions and patient indications for IO administration:
Amputations, difficult pokes, burns, children
Explain appropriate sites for IO admin:
Long bones, tibia, femur, sternum
Explain the benefits of IO medication administration:
- Insertion of the Io needle is quick and easy
- All resuscitation fluids, drugs, and blood products can be given via the IO route
List medical conditions and patient indications for endotracheal medication administration:
Unable to tolerate medication admin via oral, topical, buccal. Also for rapid effect as ET route is highly vascular
Explain the benefit of endotracheal medication administration:
When IV cannot be established and patient is in dire need of N.A.V.E.L. Rate of absorption is as fast as IV but does need to be increased 2-2.5 times
