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64 Cards in this Set

  • Front
  • Back
Percent of body weight that is water
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.
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.
Compoents of sodium bicarbonate and its chemical sign:
3 Oxygen
A process in which molecules move from an area of higher concentration to an area of low concentration.
IE. Diffuse the party.
The net effect of osmosis
Low to high
The net effect is to equalize the solute concentration on both sides of the membrane.
The internal enviroments' resistance to change, maintaining a balance.
S & S of dehydration and causes
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.
Characteristics and causes of overhydration
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.
The cardinal sign of overhydration is...
Osmolarity and isotonic solutions
Have almost the same osmolarity concentration of sodium, as serum and other body fluids.
Components of NS
Isotonic solution
0.9% of sodium chloride
Considerations of isotonic solution administration in CHF pts
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.
Characteristics of colloid solutions
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.
Types of peripheral veins
Hand, arm, EJ, lower ext
Questions to ask prior to IV solution determination
-Is the pt critical?
-Is the pt stable?
-Does the pt need fluid replacement?
-Will the pt need medication?
Most common IV solution in EMS
Sterile technique with the IV bag
-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
Purpose of buretrol
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
Vein determination process
-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
IV cannulation process and pitfalls
Large veins may roll use traction, stabilize vein
What "track marks" signify
Usually sign of sclerosis (hardening or thickening of tissue) by frequent cannulation or puncture of the vein, IE. Drug user/abusers.
Catheter selection
-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
Saline lock usage in prehospital setting
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.
IV Bag change process
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.
Steps in discontinuing an IV
-Shut off flow
-Remove tape
-Fold 4x4 and place over site
-Pull cath out while applying pressure
EJ Cannulation risks
The 3 main risk are:
1) Puncture to carotid artery
2) Rapidly expanding hematoma
3) Air embolism
Problems solving for the IV bag that won't flow
-Check IV fluid
-Check the administration set
-Check the height of bag
-Check the type of catheter used
-Check constricting band
Signs of infiltration
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.
Causes of thrombophlebitis
Inflammation of the vein
-Venous cannulation
-Lapses in aseptic technique
-Long term IV therapy
-IV drug abusers
-Excess motion of IV needle of catheter
S&S of hematoma
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.
Possible complication of an IV near a joint
Increase risk of perforation of tendon, ligaments, and nerves. S&S will be sudden and sever pain, numbness and tingling afterward.
Common causes of circulatory overload
Failure to set drip rate
S&S of circulatory overload
-Crackes (rales) in breath sounds
Primary cause of vasovagal reaction
Causes vaso dilation, leading to drop BP, and collapse.
S&S of catheter shear
-Sudden dyspnea
-Diminsh breath sounds
-Same as air embolus
Metric standard calculations
lb to kg and kg to lb
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
Option 2: Gives ~ by dividing the pt's weight in lbs by 2 and subtract 10% of that #
What a paramedic should do if they receive inappropriate med order?
Have them repeat order.
Do no harm. Make sure medical control understands. Communicate.
Medication administration process and considerations
6 rights
-Rt Pt
-Rt drug
-Rt dose
-Rt route
-Rt time
-Rt documentation
Drug contraindication considerations
When not to give the med
Medical asepsis
The practice of preventing contamination of the pt by using aseptic technique. Clean technique. Handwashing, wearing gloves, and keeping equipment clean.
The state of being free of pthogenic organisms.
"medically clean"
Cleaned as possible in the field.
Antiseptics vs. disinfectants
-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.
Components of minimum BSI
Wearing gloves and eye protection
Characteristics of sharps containers
-Readily accessible
-At least 2 in back of ambulance
-Sharp shuttle ava.
Types of drugs administered via rectal route
Diazepam (Valium)
Certain antimetic meds (promethazine [Phenergan])
Suppository a drug mixed in firm in firm base that melts at body temp, shaped to fit.
entral route
Any route in which medication is absorb through some portion of the GI tract. IE. oral, gastric tube, and rectal administration.
Enteral vs parenteral medication administration
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.
The most common medication route in prehospital setting
Ampule medication extraction process
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
Benefits to using prefilled syringes
Ease of use as they are much quicker and easy to use.
Where the intradermal medication route is typically used?
Physician's office or hospital setting used to test for TB
Max amount of fluid that can be used in SC
1mL or less
Steps of the IM administer
up to 5mL
Hx: Allergies etc
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
IV med bolus considerations
No room for error as it is going directly into circulatory system bypassing most barriers to drug absorption.
Considerations after administering a medication
Monitor pt for reactions
Considerations of premixed maintenance infusions
IE Lidocaine, dopamine, Epi
All of these meds require careful titration to achieve desire effect.
Types of med given via the transdermal route
Medication apply topically.
Nitro, estrogen, nicotine, and analgesic patches are ex. along with creams and paste.
Most common inhaled medication
Fastest to slowest med routes
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
Steps to control a rolling vein
distal traction and stabilize
Treatment options of "syncope after seeing the needle" pt
1) Shock position
2) High-flow O2
3) Monitor VS
4) Establish IV in case fluid resuscitation is needed
Sharps disposal procedure
ASAP, Do not pass sharps
Clinical indicators of pyrogenic reaction
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.