Week 11- Sharp Safety and Med Draws

Question 1

What is the MOH Equipment Standards for various syringes?

Answer 1

• Every ambulance will have available to the Paramedic the following syringe sizes: (ml same as cc)
  
  • 1ml or cc
  • 3ml or cc
  • 10ml or cc

Question 2

Additional Syringe Sizes

Answer 2

• 60ml
  
  • used for supraglottic airway “cuff” inflation with air
  • Also used by ACP’s for certain drugs

Question 3

What is the syringe equipped with?

Answer 3

• A syringe is equipped with a plunger allowing paramedics to draw up medication/ fluid prior to administration

Question 4

How do we read a syringe?

Answer 4

• Always use the plunger ring closest to the tip to read the volume contained in a syringe

Question 5

How do we write/ document medical amounts in a syringe?

Answer 5

• Always include a “0” in front of a decimal when needed
  Ex. 0.3ml of epinephrine

Question 6

What is a sharp?

Answer 6

A sharp is any object that is able to cut the skin

Question 7

Conventional Sharps is EMS

Answer 7

• EMS Needlestick injuries:
  involves a Paramedic accidentally sticking themselves with a needle
• “Dirty” meaning just withdrawn from a patient’s skin- may contain blood & other pathogens (Hep B/ Hep C/ HIV)
• Can contain medication dangerous to medic- ie. epinephrine
• Or can be clean and in the process of being prepared for use

Question 8

Other Sharps

Answer 8

• Lancets, razors, scissors/open ampoule, metal & glass

Question 9

Non Conventional Sharps

Answer 9

• Has more to do with the hazardous/ harmful substance the item may contain:
  
  • IV tubing/ IV cannula/ Syringe/ Bone fragments/ teeth/ etc

Question 10

When do needle stick injuries occur?

Answer 10

• When medic is actually using the needle/ during injection
• After use- before disposal
• Between steps in procedures
• During sharp disposal

Question 11

What are some prevention of sharp injuries?

Answer 11

• PPE- wear gloves/ eye wear “goggles”
• Attend training & known safety policies surrounding sharp safety
• Use equipment properly- i.e. blunt tip needle, engaging safety features on injection needles, sharp containers, etc
• Ensure personal health, such as immunization is current
  i.e. Hep B vaccine
• Post Exposure Management Knowledge:
  
  • Know how to report an injury, how to seek out treatment

Question 12

What is the treatment plan and management of needle stick injury?

Answer 12

1. bleed it
2. wash it
3. cover it
4. report it

Question 13

MOH Standards for every ambulance, Syringe vs Needle

Answer 13

• 22g in 1/2 inch size/ & 25g in both 1” & 5/8th size
  
  • Attached to syringe (slip on/ or leur lock)
  • Used for injections- piercing the skin for the purpose of administering a medication/ fluid
  • SQ/ IM/ IV
• Blunt tip- 18g
  
  • For drawing up meds or fluid from a container (Ampoule/ Nebule/ Vial/ Intravenous bag
• NOT USED FOR INJECTING THE MEDICATION INTO THE SKIN

Question 14

Intramuscular (IM)

Answer 14

• Means you need a longer needle to hit the muscle & will enter at 90 degree angle
• i.e. adult pt. would need a 1” to 1.5” length. Infant might be 5/8 the length.
• Skin is pulled tight during injection

Question 15

Subcutaneous (SQ)

Answer 15

• Means in the subcutaneous level of the skin at a 45 degree angle
• The 5/8th needle is selected
• Skin is “pinched” as to not hit the muscle

Question 16

Needle Safety Features

Answer 16

• Always inject with “bevel up”
• Activate safety cover upon withdrawing from skin
• Most Paramedic services have chosen needles with “safe features to reduce needle stick injuries”

Question 17

How do we discard a needle?

Answer 17

After drug administration with a needle:
- Activated upon withdraw from pt
- To reduce “sharp” injury
- Newer “safety” covers can actually be activated immediately upon injection withdraw from pt

Question 18

What are the routes for drug administration?

Answer 18

• Parenteral (injected through skin)
• Enteral (injected through mouth)
• Topical (applied to body)
• Intranasal (injected through nose)
• Inhalation (injected through inhaling)
• Transdermal (patch on skin)

Question 19

Parenteral Route

Answer 19

• Drugs avoid the “gut”
• Drug is given outside or avoid GI tract
• Problem: once given cannot be taken back

Question 20

Enteral Route

Answer 20

• Drug administered via GI tract
• Via the mouth- easy to administer
• Often absorbed within GI tract
  
  • Oral/ Buccal/ Sublingual/ Rectal/ Inhalation

Question 21

What does parenteral routes include?

Answer 21

• IV: intravenous
• IM: intramuscular
• SC or SQ: subcutaneous
• Other: ACP skill “IO”- introsseous (into the bone)

Question 22

Ampoule

Answer 22

• Cannot be reused, intended for single use, cannot be resealed. Often glass
• Possess a “neck” that needs to be cracked in order to access the medication
• Odd shape/ various sizes

Question 23

Vial

Answer 23

• Can be reused, often have a rubber stopper on top for multiple doses
• May or may not be sealed once proactive lid removed
• Flat top/ various sizes

Question 24

Plastic Nebules

Answer 24

• Often “light” sensitive
• Kept in “foil” packaging when not in use
• Medication is squeezed out into medication cup
• Syringe can be used when smaller doses required

Question 25

What other drug packaging for ACP’s?

Answer 25

• ACP’s also have “pre-loaded” syringes for intravenous administrations

Question 26

How to prevent drug errors in the prehospital setting?

Answer 26

• Medical error: any preventable event that may cause or lead to an inappropriate medication use or pt harm while the medication is in the control of the Health Care Professional
• Pt safety has to be a priority!!

Question 27

What are the 5 rights to drug administration?

Answer 27

1. Right drug
2. Right patient
3. Right dose
4. Right route
5. Right time

Question 28

Right Drug

Answer 28

1. what is your working diagnosis?
2. Which medical directive will you initiate?
3. Does the pt meet the indications for a particular medical directive?
4. Show the drug to their partner & ask for their partner to state the “name”.

Question 29

Right Patient

Answer 29

1. Is this pt right for this drug?
   - Does the pt meet indications for this drug?
2. Is the drug contraindicated for this pt?
   - Med. hx?/ allergies?/ vital signs?

Question 30

Right Dose

Answer 30

1. What does the medical directive state?
2. Have you selected the proper working diagnosis?
3. Do you need to calculate pt’s age and or weight to figure out the proper dose?
4. Are you using the proper drug weight? ml/ mcg/ mg/ g
5. Is this to be titrated? Meaning you keep administering until the desired result has been obtained…

Question 31

Right Route

Answer 31

1. What is the administration order as outlined within the medical directive?
2. Have you selected the proper route for this particular drug?
3. Are you administering the medication properly?

Question 32

Right Time

Answer 32

1. According to the medical directive are you administering the drug at the proper time during the assessment?

Question 33

Checking the 5 rights

Answer 33

• A paramedic will ensure the 5 rights are confirmed with their partner
• This will assist in reducing medication errord

Question 34

What are the additional rights?

Answer 34

• Right to know
• Right to refuse
• Right documentation

Question 35

What are the PCP medication routes?

Answer 35

1. SQ or (SC): Subcutaneous
2. IM: intramuscular
3. IN: intranasal
4. Neb: nebulizer
5. SL: sublingual
6. MDI: metered dose inhaler
7. Oral

Question 36

What medication do we give oral?

Answer 36

• ASA, Ibuprofen, Acetaminophen, Glucose tablets

Question 37

What medications do we inject?

Answer 37

• Epinephrine, Dimenhydrinate, Diphenhydramine, Naloxone, Ketorolac, Glucagon

Question 38

What medications do we give intranasal?

Answer 38

• Naloxone

Question 39

What medication is given nebulized?

Answer 39

• Salbutamol, Epinephrine

Question 40

Sublingual Medication

Answer 40

• Nitroglycerin