Chapter 11: Ready for Review
•The cellular environment contains charged ions, called electrolytes, that are used by the cell for different purposes. These electrolytes include sodium, potassium, calcium, bicarbonate, chloride, and phosphorus. Their electrical charges must remain in balance on either side of the cell membrane.
•There must be a balance of compounds on either side of the cell membrane. If an imbalance occurs, the cell can move chemicals or charges across its membrane by various methods, including osmosis, diffusion, active transport, and filtration.
•Understanding the workings of the intracellular and extracellular chemicals and charges will provide you with a better foundation for understanding why different types of IV solutions are administered for different conditions.
•Techniques for gaining vascular access include cannulation of a peripheral extremity vein, cannulation of the external jugular vein, and cannulation of the IO space. Although the ultimate goal of vascular access is to be able to administer fluids and medications, each of these techniques requires a different approach and must be practiced frequently for initial and ongoing proficiency.
•Several different IV administration sets exist, and you must know which one is most appropriate for a given patient condition. Microdrip sets (60 gtt/mL) are commonly used for medication infusions. Macrodrip sets (10 or 15 gtt/mL) are used when the patient requires IV fluid boluses to treat dehydration, hypovolemic shock, and other states of hemodynamic instability.
•You must consider two factors when choosing an IV catheter: gauge and length. The larger the gauge (the smaller the number), and the shorter the length, the more fluid that can be infused through it. Over-the-needle catheters are the most commonly used IV catheters in the prehospital setting.
•Cannulation of a peripheral extremity vein is the preferred initial means of establishing vascular access. If it is unsuccessful and the patient is critically ill or injured, proceed with IO cannulation without delay. External jugular vein cannulation is usually attempted only after all other techniques of gaining vascular access have failed.
•IO cannulation and infusion are no longer reserved for children only; they can also be used to establish emergency vascular access in adults. The IO space, which acts like a sponge, quickly absorbs fluids and medications and rapidly transports them to the central circulation.
•Although peripheral veins often collapse when a patient is in shock or cardiac arrest, the IO space tends to remain patent. Thus IO cannulation and infusion—in children and adults—may be life-saving measures if peripheral venous access is not possible. Any fluid or medication that can be administered via the IV route can be administered via the IO route and can travel to the central circulation just as rapidly.
•You must be thoroughly familiar with the equipment you are using when performing IO cannulation. Follow local protocols and attend in-service training regarding the specific equipment used for IO cannulation in your EMS system.
•Use aseptic technique when you are performing any invasive procedure to minimize the risk of patient contamination. Always use standard precautions when performing an invasive procedure to maximize your own safety.
•Along with the dispensing of medications comes the responsibility to be thoroughly familiar with each medication carried on your ambulance. Be sure to confirm the drug doses and routes. Remember: First do no harm.
•Good math skills and a thorough understanding of the metric system are imperative to providing the right dose of a drug to your patient. The six rights of medication are right patient, right drug, right dose, right route, right time, and right documentation. Administering the wrong drug, using the wrong route, or giving the wrong dose can have disastrous effects.
•All equipment used in the administration of medications must be kept sterile to prevent contamination of the patient. Use proper standard precautions to protect yourself. Needleless systems have made older needle systems increasingly obsolete because the former systems decrease the incidence of needlesticks.
•As a paramedic, you must be familiar with the various routes of medication administration, including the proper use of equipment and proper anatomic locations for administration via each route.
•Enteral medication administration includes the administration of all drugs that may be given through any portion of the gastrointestinal tract. The parenteral route includes any method of drug administration that does not pass through the gastrointestinal tract.
•The IV and IO routes are the fastest routes of medication administration; the oral and transdermal (topical) routes are the slowest.
•When in doubt, always follow local protocols or contact medical control as needed for direction when you are administering a medication. Never make a hasty critical decision before consulting with a physician!