EMRG1300 Flashcards
IV Therpy MD- Indications
Actual or potential need for IV medication or fluid therapy
IV Therapy MD- Conditions
IV Cannulation:
- Age: ≥ 2 years
0.9% NaCl- Fluid Bolus:
- Age: ≥ 2 years
- SBP: Hypotension
IV Therapy MD- Contraindications
IV Cannulation:
- Suspected fracture proximal to access site
0.9% NaCl Fluid Bolus:
- Fluid Overload
IV Therapy MD- Treatment 0.9% NaCl Maintenance Infusion
Age: ≥ 2 years to < 12 years
Infusion: 15ml/hr
Age: ≥ 12 years
Infusion: 30-60 ml/hr
IV Therapy MD- Mandatory Provincial Patch Point
Patch to BHP for authorization to administer 0.9% NaCl fluid bolus to hypotension pt’s ≥ 2 to < 12 years with suspected DKA
IV Therapy MD- 0.9% NaCl Fluid Bolus
Age: ≥ 2 years to < 12 years
Infusion: 20ml/kg
Reassess every: 100ml
Max Volume: 2000ml
Age: ≥ 12 years
Infusion: 20ml/kg
Reassess every: 250ml
Max Volume: 2000ml
Paramedics can monitor an IV line for fluid replacement:
- A max flow rate of up to 2 ml/kg/hr to a max of 200ml/hr
- Thiamine, multivitamin preparations
- Drugs within his/her level of certification
- Potassium chloride for patients ≥ 18 years of age, to a max of 10mEq in a 250 ml bag
A paramedic shall request a medically responsible escort in the event a patient requires an IV for:
- Blood (or blood products) administration
- Administering potassium chloride to a patient who is < 18 years of age
- Administering medication that is outside his/her scope of practice
- Requires IV fluid infuser, pump, or central venous line
- Neonate or pediatric pt < 2 years
What should the paramedic do pre-transport? (IV Line Standard)
- Confirm physicians written order with sending facility staff
- Determine IV solution, IV flow rate, catheter gauge, catheter length, and cannulation site
- Note the condition IV site prior to patient transport
- Confirm amount of fluid remaining in bag
- Determine amount of fluid required for complete transport time and obtain more fluid if applicable
- Document all pre-transport IV information
What should the paramedic do during transport? (IV Line Standard)
- Monitor and maintain IV at the prescribed rate, this may include changing the IV bag as required
- If IV becomes dislodged or interstitial, discontinue the IV flow and remove the catheter with aseptic technique
- Confirm condition of catheter if removed
How much fluid should be remaining when you change the IV bag?
Approximately 150 mls of solution
What is PCP Assist IV?
Authorization for a PCP to cannulate a peripheral IV at the request and under the direct supervision of an ACP
- They ARE NOT authorized to administer IV therapy
What is PCP Autonomous IV?
Authorization for a PCP to independently cannulate an IV according to the MD.
- They ARE authorized to administer IV therapy
ROSC MD- Indications
Pt with ROSC after resuscitation was initiated
ROSC MD- Conditions
0.9% NaCl Fluid Bolus
- Age: ≥ 2 years
- SBP: hypotensive
- Other: Chest auscultation is clear
ROSC MD- Contraindications
Fluid Overload
ROSC MD- What do we titrate oxygenation to?
94-98%
ROSC MD- What do want to avoid with ventilations?
Hyperventilation- target ETCO2 to be between 30-40mmHg
ROSC MD- Treatment 0.9% NaCl Fluid Bolus
Infusion: 10ml/kg
Interval: Immediate
Reassess every:
100 ml for ≥ 2 years to < 12 years
250 ml for ≥ 12 years
Max Volume: 1000 ml
Conditions for Trauma TOR
Age: ≥ 16 years
No palpable pulses
No defib delivered
Rhythm asystole
No signs of life since extricated OR
signs of life since extricated and closest ED is ≥ 30 mins OR
Rhythm PEA and closest ED is ≥ 30 mins
Conditions for Medical TOR
Age: ≥ 16 years
Paramedic did not witness arrest
No ROSC 20 min of resus
No defib delivered
No reversible cause of death
What are crystalloids?
Dissolving crystals such as SALTS and SUGARS in water. Contain NO PROTEIN!!!
