Terms
Sympathetic vs. parasympathetic
Sympathetic: "fight or flight"; handles situations where the body responds to stress or danger
Parasympathetic: "rest and digest"; "feed and breed"; returns body to resting state and serves to prepare for next episode of stress
Activation of an alpha 1 receptor causes _____
Activation of a beta 1 receptor causes _______
Activation of a beta 2 receptor causes _______
1) vasoconstriction
2) Increased HR and SV
3) Bronchodilation
Briefly describe:
Fast-One device
B.I.G. device
1) Sternal placement; has multiple barbs embedded when the device is pressed into place
2) A spring-loaded device that fires needle into place
Describe how a medic would determine a patient's weight in kg
Divide pounds by 2.2
What are the two main types of IV fluids and which of those is the one used in the prehospital environment?
List three reasons why giving larger amounts of NS than prescribed is potentially bad.
1) Crystalloid and colloid; crystalloid
2) lowered body temperature, lowered pH levels, messes up clotting agents
Agonist vs. antagonist
Agonist: activates a receptor
Antagonist: Prevents activation of a receptor
Define:
Tonicity
Isotonic
Hypotonic
Hypertonic
Difference between tonicity and pH
1) salt content compared to body fluids
2) same salt content as body fluids
3) lower salt content than body fluids
4) higher salt content than body fluids
5) tonicity = salt, pH = hydrogen ion concentration (acidity/alkalinity)
Describe how to find the proximal tibia landmark for IO
Locate tibial tuberosity, move fingers medially and a bit distally, locate flat spot
How many mg in one mcg?
How many mcg in one mg?
1) 0.001
2) 1000
Bolus:
Standard amount calculation
Minutes supposed to give the calculated amount
The general guideline for hypovolemic patients
Signs of fluid overload that will be checked for in-between incriments of bolus
1) 20cc/ideal body weight
2) 10
3) 20cc/kg; max 2L
4) lung sounds, new signs of dyspnea, new JVD
Define sympathomimic
A substance that mimics the action of epinephrine/norepinephrine/dopamine
Define the aseptic technique
Eliminating sources of contamination on the skin of the patient and avoiding contact with sterile parts of the IV catheter and IV set
Describe how to find the humeral head landmark for IO
Pronate arm (thumbs outward or arm across chest) then locate humeral head ("karate chop" method)
If you put 1 mg of epinephrine into 250cc of IV fluid, the concentration you get is 0.004mg per cc. How many micrograms per cc is that?
4
Describe the proper procedure for setting the rate at "tko."
Roll the roller clamp to where it has almost stopped all flow; usually a drop every 3-4 seconds; just enough "to keep open"/tko
Define:
Chronotropy
Dromotropy
Inotropy
1) related to HR
2) related to the speed of conduction in the cardiac electrical system
3) related to SV
What is an infusion pump?
Why would an EMS service use infusion pump sets for IVs that are not on a pump?
1) A machine that regulates the flow of an IV
2) It is faster to switch to the infusion pump at the ER
Explain why a medic may choose one of the main IO sites over the other
Humeral head allows for large volume flow in almost every case; tibial lines may not flow fast
If you are running an IV on a micro drip set at one drop per second, how many drops per minute is that?
If you are running an IV on a micro drip set at one drop per second, how many cc's per hour is that?
If you are running an IV on a micro drip set at one drop every other second, how many drops per minute is that?
If you are running an IV on a micro drip set at one drop every other second, how many cc's per hour is that?
If you are running an IV on a 20 drop macro drip set at one drop per second, how many drops per minute is that?
If you are running an IV on a 20 drop macro drip set at one drop per second, how many cc's per hour is that?
If you are running an IV on a 15 drop macro drip set every other second, how many cc's per hour is that?
1) 60 ( 60 sec = 1 min, 1 drop/min = 60drops/60sec)
2) 60
3) 30 (60/2 = 30)
4) 30 (60/2 = 30)
5) 60
6) 180 (60/20=3; 3 is the factor 60*3 = 180)
7) 120 (60/15 = 4; 4 is the factor 60 sec/min / 2 (every other drop) = 30 30*4 = 120)
We teach that there are three basic drip rates for the standard IV of NS in EMS- ________, ________, and ________.
tko
wide open
30 drops per minute
Define (in terms of medicine):
Action
Indication
Contraindication
Side Effect
Reconstitute
1) What it does to the body
2) Why that medication would be utilized
3) A reason why that medication should not be utilized
4) An unintended but not surprising effect
5) Fluid must be added to the medication and carefully mixed
Define and describe the function of the injection port on an IV set
Accesses to IV that allows medications to be delivered into IV by syringe or piggyback of another IV
List the steps in an IO insertion in order
Find it, clean it, mark it, DON"T TOUCH IT AGAIN, poke it (to bone), drill it, hold it, remove drill, unscrew inner trochar, attach holder, attach extension, aspirate it, flush it, attach IV, secure it
Your medical control physician tells you to run the IV on your dehydrated patient wide open until you have given a fluid bolus of 500cc and then set the IV at 100cc/hr. Your service uses 15 drop sets. How many drops per minute will give you 100cc/hr?
What if you were using a 20 drop set?
What if you were using a 10 drip set?
1) 100cc/hr
60 (drops/min)/15(drop set) = 4 (factor)
100(cc/hr)/4(factor)=25 25 drops/min
2) 100cc/hr
60/20 = 3
100/3 = 33.33333 33 drops/min
3) 100cc/hr
60/10 = 6
100/6 = 16.66666 17 drops/in
List the steps in order for an IV start
Apply tourniquet, select site, clean site, mark site, DON'T TOUCH ANYMORE, pull skin tight to limit vein movement, insert catheter, get blood flashback, threat catheter, occlude site, remove needle, dispose of needle, attach IV, pop tourniquet, flow IV, adjust flow, secure IV