wHUt we gonNA dU • IV Maintenance • Bleeding and Shock Chs 22 & 23 • Soft Tissue Injuries Ch 24 • Chest Injuries Ch 27 • Injuries to ABD and Genitalia Ch 28
Mar 27, 2015
wHUt we gonNA dU
• IV Maintenance• Bleeding and Shock
Chs 22 & 23• Soft Tissue Injuries
Ch 24• Chest Injuries
Ch 27• Injuries to ABD and Genitalia
Ch 28
IV MAINTAINCE
• I Defined
To manage and troubleshoot a pre-established IV line
• II Three reasons for an IV line
Volume Replacement
Fluid Replacement
Medication Route
• III Common Sites
Lateral aspect of Upper Extremity
Anterior aspect of elbow
anticubital fossa
Back of hand
• IV Common Fluids
Crystalloid
a. Does not contain proteins or large molecules
b. Examples are D5W and NS
Colloid
a. Contains proteins or other large moleculesb. Examples are albumin
• IV The EMT-B can transportCrystalloid solutionsVitaminsNS { cannot exceed 0.9% [ ]KCL { cannot exceed 20 mEq
• VI What the EMT-B cannot transport
Piggy back or secondary set
Blood products
Antibiotics
Central line with fluid / medication infusing
• VII Responsibilities of the EMT-B when managing an IV
Keep the IV patent and maintain the desired rate.Handle the pt. in a way that will not
jeopardize the IV.To monitor and identify complications and take appropriate steps.
• VIII Complications
Over hydration
may cause pulmonary edema or CHF
{follow advice of medical control}
Clot occlusion
a blood clot has formed in or around IV catheter { follow advice of medical
control}
Infiltration
fluid is leaking into surrounding tissue
IV site will be cold and puffy
There is no blood return in the tubing
{follow advice of medical control}
Positional IV
IV may become occluded when pt. moves
catheter may rest against wall of vein
[ reposition the pt’s extremity, or IV tubing, Catheter/tubing connection]
{follow advice of medical control}
Pyrogenic ReactionDefined: Foreign material enter the body as
a result of contaminated fluidS / S: Abrupt elevation of temperature
chillsbackacheheadacheweaknessN / VOther s / s of shock
{Discontinue IV immediately}
{Contact and follow advice of medical control}
Allergic Reaction
A result of poor aseptic technique
{Contact medical control and follow advice}
• IX Types of catheters
The smaller the number, the bigger the needle.
14 to 20 gauge are common for adults
20 to 25 gauge are common for children
The length will vary from ½” to 3”
Multiplication and division
• Fractions
• Decimal fractions
• Proportions
• Percent
Mathematical Equivalents used in pharmacology:• Grams – mass• 1mg = 1cc• Meters – distance• Liters – volume
1L = 1000ml• Weight
1kg = 2.2lbs
Calculating dosages for infants and children
• Body weight
20ml/kg for hypovelemic shock
• Use of tables, charts and other adjuncts
Broslow Tape
Administration sets
• Macro
15gtts = 1ml
• Micro
• 60gtts = 1ml
• Fluid over time
Volume to be adm. (set)
time in minutes
Adm. 500 mL over 60 min. using 10 ggt set:
500 mL (10)
60
5000 / 60 = 83.3 or 83 gtts/min
• Infusion time
If you are transporting an IV antibiotic, how long before it will be infused?
Set: 60 gtt
Rate: 45 gtt/min
100 ml bag
45 gtt/min = (100 mL) (60 gtt set)
x
45 gtt/min = 6,000 mL gtt/min
x
X = 6,000 mL gtt/min
45 gtt/min
X = 133 minutes
Hypertonic
• higher solute [] than do the cells
• Shift – out of intracellular to extracellular
• Solute- dissolved in another substance
Hypotonic
• Lower solute [] than do the cells
• Shift – out of extracellular to intracellular
• LR is isotonic
• NS is isotonic
• D5W is hypotonic