Wk 8 100 - NC

Pre-EMS Call Medication Check

Ensure all equipment on the ambulance is fully functional, verify medications are not expired or damaged, and ensure medications are readily available in the correct quantity.

Familiarity with Drug System

Be thoroughly familiar with the system used for exchanging and replacing outdated or damaged drugs.

Pre-EMS Call Medication Check

Ensure all equipment on the ambulance is fully functional, verify medications are not expired or damaged, and ensure medications are readily available in the correct quantity.

Familiarity with Drug System

Be thoroughly familiar with the system used for exchanging and replacing outdated or damaged drugs.

Documentation and Security

Be responsible for the documentation and security of all controlled substances carried on the ambulance and account for all controlled substances that were wasted.

Follow Policies and Procedures

Adhere to local policies and procedures for drug distribution, security, and accountability.

Medical Asepsis

Practice of preventing contamination of the patient using aseptic technique, aimed at preventing contamination when performing invasive procedures.

Clean Technique vs. Sterile Technique

Some equipment in the prehospital environment is sterilized for patient safety; sterile technique is the destruction of all living organisms using heat, gas, or chemicals.

Examples of Medical Asepsis

Handwashing, wearing gloves, and keeping equipment clean.

Medically Clean

Cleaning the patient site with iodine and alcohol before starting an IV.

Contamination Prevention

If an IV catheter falls or contacts a contaminated surface, discard it and use a new one.

Antiseptics

Used to cleanse areas before invasive procedures and are non-toxic to living tissues.

Common Antiseptics

Isopropyl alcohol (rubbing alcohol) and iodine.

Disinfectants

Toxic to living tissues; should only be used on nonliving objects.

Common Disinfectants

Virex, Cidex, Microcide, and sodium hypochlorite (bleach).

First Rule of Routine Precautions

Treat all body fluids as potentially infectious.

Disposal of Contaminated Equipment

After an IV catheter or needle penetrates a patient's skin, it becomes contaminated.

Sharps

Contaminated items that can cause injury, including IV needles and catheters, broken ampules or vials.

Safety Practices to Minimize Risk of Needlesticks

Follow the agency's exposure control plan.

Total Body Water (TBW)

Comprises 60% of adult body weight (approx. 42 kg in a 70-kg patient).

Intracellular Fluid (ICF)

45% of body weight (about 28 L), inside the cells.

Extracellular Fluid (ECF)

15% of body weight (about 14 L), outside the cells.

Interstitial Fluid

10.5% of body weight (approx. 10 L), bathing the cells.

Intravascular Fluid (Plasma)

4.5% of body weight (approx. 4 L), within blood vessels, transporting cells and nutrients.

Fluid Movement

Continuous movement of fluids and solutes between compartments.

Homeostasis

Maintains consistency in content and composition.

Imbalance

Leads to disease or issues.

Solvent

Fluid that dissolves substances (water in the body).

Solute

Dissolved particles (e.g., electrolytes, nonelectrolytes).

Electrolytes

Charged atoms or molecules that conduct electricity when dissolved in water.

Cations

Positive charge (e.g., sodium, potassium, calcium, magnesium).

Anions

Negative charge (e.g., bicarbonate, chloride, phosphate).

Electrolyte Measurement

Measured in millimoles per liter (mmol/L).

Electrolyte Balance

Regulates essential body functions like water levels, muscle contractions, and cardiac function.

Sodium (Na+)

Main cation in extracellular fluid; regulates water distribution and cellular perfusion.

Potassium (K+)

98% inside cells, principal intracellular cation; regulates neuromuscular function and glucose metabolism.

Hypokalemia

Low potassium causes muscle, GI, and cardiac disturbances.

Hyperkalemia

High potassium causes hyperstimulation of nerve cells, leading to cardiac arrest.

Calcium (Ca+2)

Essential for bone growth, muscle function, heart muscle, nerve function, and blood clotting.

Hypocalcemia

Low calcium causes muscle cramps, spasms, hypotension, and vasoconstriction.

Hypercalcemia

High calcium causes muscle weakness, lethargy, ataxia, vasodilation, and flushed skin.

Magnesium (Mg+2)

Coenzyme in protein and carbohydrate metabolism; controls neuromuscular irritability similar to calcium.

Bicarbonate (HCO3−)

Regulates acidosis and alkalosis; critical in the carbonic acid/bicarbonate buffer system.

Chloride (Cl−)

Regulates extracellular fluid and stomach pH.

Phosphorus (P)

Component of adenosine triphosphate (ATP), the body's energy source.

Nonelectrolytes

Substances without an electrical charge, including glucose and urea.

Glucose

Normal blood concentration is 4 to 8 mmol/L.

Governing Principle

Unequal concentrations of water and electrolytes across a cell membrane will move to balance on both sides of the membrane.

Concentration Gradient

Created when concentrations of charges or compounds are higher on one side of the membrane.

Diffusion

Movement of particles from high to low concentration.

Filtration

Movement of water and dissolved compounds through cell membranes, commonly used by kidneys to clean blood.

Active Transport

Uses energy (ATP) to maintain imbalances of compounds across the membrane.

Osmosis

Movement of water from low solute concentration to high concentration through a selectively permeable membrane.

Homeostasis (Disturbances)

The body's ability to maintain a stable internal environment; illness can disrupt this balance, leading to fluid and electrolyte imbalances.

Normal Fluid Loss

A healthy person loses 2 to 2.5 L of fluid daily through urine, exhalation, and skin.

Dehydration

Inadequate total systemic fluid volume.

Common in Dehydration

Older adults and young children.

Dehydration Process

Fluid shifts from the vascular to interstitial and intracellular compartments, leading to a systemic fluid deficit.

Dehydration Signs and Symptoms

Decreased consciousness, Orthostatic hypotension, Tachypnea, Dry mucous membranes, Tachycardia, Poor skin turgor, Flushed, dry skin.

Causes of Dehydration

Diarrhea, vomiting, gastrointestinal drainage, hemorrhage, insufficient fluid/food intake.

Overhydration

Increased total systemic fluid volume.

Overhydration Process

Fluid fills the vascular compartment, moves into the interstitial compartment, and then into the intracellular compartment.

Risks of Overhydration

Can lead to edema or even death.

Overhydration Signs and Symptoms

Shortness of breath, Puffy eyelids, Edema, Polyuria, Moist crackles (rales), Acute weight gain.

Causes of Overhydration

Unmonitored IV lines, kidney failure, prolonged hypoventilation.

Sterility of IV Fluids

Each IV fluid bag is sterile, with the compounds and ions in the solution being identical to those in the body.

Sodium as Benchmark

Sodium concentration is used to calculate a solution's tonicity.

Sodium Concentration in Body Cells

The concentration of sodium in body cells is approximately 0.9%.

Altering Sodium Concentration

Altering sodium concentration in IV solutions can move water into or out of fluid compartments in the body.

Types of IV Solutions

Three Basic Types: Crystalloids, Colloids, Blood Products.

Crystalloid Classification

Isotonic, Hypotonic, Hypertonic.

Fluid Movement in IV Fluids

IV fluids can affect tonicity of the extracellular fluid (ECF), with potential serious consequences.

Isotonic Solutions Definition

Have almost the same osmolarity as serum and other body fluids.

Isotonic Solutions Effects

Expands the intravascular compartment without noticeable fluid shifts to/from other compartments.

Indications for Isotonic Solutions

Used for hypotensive or hypovolemic patients.

Precautions for Isotonic Solutions

Careful to avoid fluid overload, especially in patients with hypertension or heart failure.

Examples of Isotonic Solutions

Normal Saline (0.9% Sodium Chloride), Lactated Ringer (LR), D5W (5% Dextrose in Water).

Hypotonic Solutions Definition

Osmolarity lower than that of serum.

Hypotonic Solutions Effects

Dilutes serum and causes water to move from the vascular compartment to the interstitial compartment.

Indications for Hypotonic Solutions

Hydrates cells while depleting the vascular compartment.

Risks of Hypotonic Solutions

Sudden fluid shift may cause cardiovascular collapse or increased intracranial pressure (ICP).

Example of Hypotonic Solutions

D5W when used for an extended period.

Hypertonic Solutions Definition

Osmolarity higher than that of serum, meaning they have a higher ionic concentration than serum.

Hypertonic Solutions Effects

Pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment.

Indications for Hypertonic Solutions

Stabilizes blood pressure, increases urine output, and reduces edema.

Precautions for Hypertonic Solutions

Careful monitoring is required to prevent fluid overload, especially in patients with heart or kidney issues.

Crystalloid Solutions

Contain dissolved crystals (salts or sugars) in water.

Effectiveness of Crystalloid Solutions

Cross membranes and alter fluid levels, making them suitable for prehospital care of injured patients needing fluid replacement.

Replacement Rule

3-to-1 Replacement Rule: For every 1 mL of blood lost, 3 mL of isotonic crystalloid solution is required.

Fluid Loss from Crystalloid Solutions

Two-thirds of infused crystalloid solution will leave the vascular spaces in about 1 hour.

Caution for Crystalloid Solutions

Crystalloid solutions cannot carry oxygen.

Large Fluid Boluses

Large fluid boluses (10-20 mL/kg) should maintain perfusion, not raise blood pressure to normal levels, to avoid diluting remaining blood volume and interfering with hemostasis.

Colloid Solutions

Contain large molecules (typically proteins) that cannot pass through capillary membranes and stay in the vascular compartment.

Effects of Colloid Solutions

High osmolarity draws fluid from the interstitial and intracellular compartments into the vascular compartment.

Colloid Solutions Effectiveness

Effective in reducing edema and expanding the vascular compartment.

Risks of Colloid Solutions

Can cause dramatic fluid shifts, placing the patient in danger if not controlled.

Colloid Solutions Usage

Rarely used in prehospital settings.

Examples of Colloid Solutions

Albumin, dextran, pentaspan.

Oxygen-Carrying Solutions Best Option

Whole blood is the best fluid to replace lost blood, as it contains hemoglobin, which carries oxygen to cells.

Use of O-negative Blood

O-negative blood (universally compatible) may be used in some prehospital settings (e.g., aeromedical or mass-casualty situations).

Synthetic Blood Substitutes

Research and trials are ongoing with synthetic blood substitutes that can carry oxygen and expand circulating volume.

IV Therapy Definition

Involves cannulation of a vein with a catheter to access the vascular system.