Download Ready for Review - Paramedic EMS Zone

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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 phosphorous. 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 practised 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,
hypovolaemic shock, and other states of haemodynamic instability.
You must consider two factors when choosing an IV cannula: 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 cannulas are the most
commonly used IV cannulas 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 lifesaving 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 guidelines and attend in-service training
regarding the specific equipment used for IO cannulation in your ambulance
service.
Use aseptic technique when performing any invasive procedure to minimise the
risk of patient contamination. Always use universal precautions when performing
an invasive procedure to maximize your own safety.
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Along with the dispensing of medications comes the responsibility to be
thoroughly familiar with each medication carried on your ambulance. Carry a
pocket guide or other reference to look up unfamiliar drugs or to confirm the
doses and routes of drugs that you are familiar with. Remember: First do no harm.
Good maths 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 universal precautions to protect
yourself. Needleless systems have made older needle systems increasingly
obsolete, as 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 anatomical
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 guidelines or contact medical control as
needed for advice when administering a medication. Never make a critical
decision in haste or without consulting a doctor!