Archive for April 2011
Like any other type of medication, antimicrobial medications should be administered under the same guidelines and procedures. It is very important that the nurse determines if the patient has allergies to drugs, foods, anything in the environment, or a family history of allergies to antibiotics. This information can help the nurse to determine if certain antimicrobial medications should or should not be administered. If allergies are identified, they should be listed clearly and in red on the patient’s record. It is a good idea to always ask a patient if they have allergies every time you administer antimicrobial medication as an emt or paramedic.
When administering antimicrobial medications, you should have emergency medications on hand in case of an allergic reaction. Some examples of drugs that are commonly used to treat side effects associated with antibiotics include antihistamines, epinephrine and steroids. The patient should be monitored for half hour following the administration of antibiotic medication. Most adverse reactions will occur during this time.
The therapeutic effect of antibiotics can be monitored. The best way to do this is to document the signs and symptoms of the disease as well as obtaining the patient’s white blood cell count.
Antibiotic medications should be administered according to the prescriber’s orders so that a therapeutic amount is maintained in the blood. If less than the therapeutic amount is taken, the treatment could be ineffective. Sometimes a double dose of an antibiotic is prescribed so that the therapeutic level is achieved quickly. This type of dose is called a loading dose.
Some antibiotics are administered via intramuscular injections that are given deep into the muscle. The injection sites should be rotated if more than one injection is prescribed. Rotating sites will help to prevent infection and reduce pain from repeat injections.
Most patients who required antibiotic medication are give prescriptions that last several days. It is important that the antibiotic is taken for the prescribed amount of time. It is common that antibiotic orders are only 72 hours. Usually this is enough time to get the results of a culture and sensitivity test. To prevent microbial resistance, most antibiotic medications are not renewed.
Microorganisms are extremely formidable enemies. The body must employ all of its natural defenses to have any chance of winning against many types of microorganisms. With the help of antimicrobial medications, many serious bacterial infections are quickly and easily overcome. Sulmonamides and penicillin are two of the first antimicrobials developed.
Sulfonamides are considered bacteriostatic medications. A bacteriostatic medication is able to stop the growth of bacteria in the body but is not able to kill the bacteria. Penicillin, which is the first antibiotic that was discovered, is considered a bacteriocidal. This means that it is able to kill bacteria by causing the bacteria to explode into parts.
Over the years, many different types of synthetic and semi-synthetic antimicrobial medications have been developed to stop the growth of bacteria and to kill bacteria. Some medications are able to stop the growth of bacteria and kill bacteria depending on the concentrations that are taken. For example, tetracycline is a bacteriostatic and bacteriocidal medication. In small concentrations it can stop the growth of bacteria. In high concentrations it kills bacteria.
Sulfonamides and penicillin can be administered in several ways. They can either be taken orally, used topically in an ointment or cream, or parenterally. There are four reasons why sulfonamides and penicillin are effective.
1. They inhibit bacteria from growing a cell wayy.
2. They disrupt the permeability of the bacteria’s membrane making it difficult for the bacteria to survive.
3. They inhibit protein synthesis.
4. They inhibit the synthesis of essential metabolites necessary for bacterial metabolism.
Many medications that are used to stop or kill microbials have negative side effects. Some people have allergic reactions to these types of medications. Other people may have and exaggerated immune response such as rash, fever, hives, itching, chills, redness, or circulatory collapse. These common side effects are often treated with antihistimines, epinephrine or steroids.
We are surrounded by millions of microorganisms and just as many can be found in our body. Just as there are good people and bad people, helpful people and hurtful people, there are good microorganisms and bad microorganisms, helpful microorganisms and harmful microorganisms. The microorganisms that aid in digestion help the body to process vitamins and minerals. Without these helpful microorganisms the body would become deficient in many important nutrients. Other microorganisms are harmful to the body. They are called pathogens and usually cause infection, illness and disease.
There are several ways that a pathogen can enter the body. Some pathogens enter the body through the food that is ingested. Other pathogens enter the body through cuts and open wounds. Once pathogens enter the body, there is a race between the invading pathogen and the body’s natural defense system. Inflammation is one of the first response signs that the body uses to fight the invading microorganism. This response causes the blood vessels to dilate, causing them to become more permeable. The nerve endings become stimulated by the dilation and send a message to the brain that there is something wrong in that area.
Some signs of inflammation if you answer a call as an EMT or Paramedic are: redness, swelling and pain in a specific area. There are several types of infections. A local infection can cause an area of tissue to become inflammed. Infections can also affect an organ or an entire body system. These types of infections are called systemic infections or septecemia. An infection that affects multiple organs or body systems is called sepsis.
The body will respond to unwanted microorganisms by engulfing the pathogens. Phagocytic cells are deployed to destroy the invading microorganisms basically by eating them and removing any injured tissue.
Antimicrobial medications are used to help kill microbials that are in the body. There are several types of antimicrobial medications. Each different medication is used to kill specific types of microorganisms. Some antimicrobial medications can not differentiate between good or bad bacteria and will kill all of the bacteria.
When an Emergency Medical Technician (EMT) enters the scene to treat a patient it is important that the EMT consider the environment he or she is walking into. Ensuring personal safety should be a EMTs first priority before patient well-being. Once personal safety is considered, the EMT should help treat any affected patients.
If the reason for the call is due to poisoning the EMT should be careful not to come into contact with the toxin. This can be difficult if the toxin was inhaled by the patient. The inhaled toxin may still be in the air. The EMT should consider his or her safety first and determine what safety equipment to wear. A self contained breathing apparatus (SCUBA) is an effective protective device to wear if the EMT has been trained to use it. If SCUBA equipment can not be used, assistance should be requested from rescue crews.
Emergency workers should keep in mind that inhaled toxins can be invisible, odorless and tasteless. Carbon monoxide is a perfect example of a toxin that falls into all three of these categories. Sometimes identifying the toxin is difficult. An EMT should not attempt to enter an environment if it is considered dangerous. Rescuers, who are specifically trained for these types of situations, should be used to move patients to a safe environment.
Once the patient is relocated to a safe environment or the scene is considered safe, the EMT should control the patient’s airway and begin oxygen therapy. The patient should be closely monitored for respiratory problems, such as depression or arrest. Toxic poisoning can happen very quickly and can have damaging effects. Most inhaled toxins are absorbed before the EMT arrives on the scene. Once the EMT is on scene, the mission is to prevent further decline.
Some common signs of inhaled toxins include: difficulty breathing, chest pain, cough, hoarseness, dizziness, headache, confusion, seizures and altered mental status.
An EMT should collect any potential containers that could have been associated with the toxin. These containers can help to determine the best course of action for treatment.
An EMT should be familiar with how to treat patients who have come into contact with toxins, either intentionally or unintentionally. There are several types of toxins that can enter the body by the four routes: ingestion, inhalation, absorption, or injection. There are specific assessment or treatment conditions that should be used for each route of poisoning. Ingested toxins are the most common cause of poisoning. Being able to identify signs of toxic ingestion is important in helping the EMT to determine the best treatment options.
Ingested toxins are toxins that are consumed orally. If an EMT suspects that a toxin was ingested, it is important to determine what was ingested. If the patient is responsive, the EMT should ask questions about the toxin and try to determine if the ingestion of the poison was intentional. If the toxin was ingested intentionally, the EMT should make note of the patient’s mental condition.
Ingested toxins can cause nausea, vomiting, diarrhea and abdominal pain or cramping. An altered metal status can also result from ingesting toxins. Chemical burns or unusual colors around the patient’s mouth are possible signs that toxins have been ingested. Unusual breath odors can also provide important information about the type of toxin that may have been ingested.
If the EMT suspects poisoning by ingestion basic assessments should begin immediately. The EMT should check to see if the patient has an open airway. An unresponsive patient may need to have an oral or nasal airway inserted to maintain an open airway. If the patient is not breathing the EMT should immediately begin artificial ventilation. If the patient is breathing, oxygen should be administered and the patient should be monitored carefully.
Any pills, tablets, or fragments of drugs or medications should be removed from the patient’s mouth. I bite block should be inserted into the patient’s mouth before and EMT attempts to remove anything from a nonresponsive patient. The EMT should wear gloves before going into a patient’s mouth. If the patient is responsive, he or she can be asked to spit out any pills. An EMT should never stick a hand into an non cooperative patient’s mouth.
Emergency medical technicians (EMTs) have to be prepared to provide aid for many different circumstances and conditions. Poisoning emergencies are very common for both adults and children. Children tend to be very curious and often have no idea of poisons in their environment. Adults can be poisoned unintentionally or by deliberately taking an overdose of a medication or drug. Regardless of the reason, poisoning is a common reason for medical aid.
Whenever an EMT encounters a possible poisoning or overdose, basic steps should be taken when assessing the patient. It is important to evaluate the scene to ensure that it is safe. The EMT should always use protective equipment to prevent contact with bodily fluids. When assessing the patient, the EMT should play close attention to the patient’s airway, breathing and circulation. If possible, the EMT should conduct a physical examination and if possible, try to obtain a SAMPLE history.
The EMT may or may not know what toxin caused the overdose or poisoning. If the toxin is unknown, the EMT will have to investigate and gather as much information as possible. If the toxin is known, the EMT will be able to make the best treatment decisions.
Responsive patients will generally be able to give information about the type of substance or location where the substance came from that may have poisoned them. A responsive patient is usually very helpful in identifying the toxin. A non responsive patient is more challenging. The EMT will have to rely on information he is able to gather from the scene. When searching for clues the EMT should look for open containers, cans, bottles, or other types of containers. Talking with family members, friends and bystanders can also provide a lot of pertinent information.
It is critical to determine the approximate time that the toxin was either exposed to or ingested by the patient. The toxin can become more difficult to treat the longer that it is in the patient’s body systems. It is also important to determine how much exposure the patient had to the toxin. Multiple exposures can pose serious health concerns.
Patients who may have suffered a head or spinal trauma must be fully immobilized to prevent movement of any areas that may be injured. The patient’s entire body may be immobilized even if only a small area of the spinal column is injured. There are several immobilization devices that can be used to prevent further injury.
A cervical spine immobilization device is used whenever a spinal injury is suspected. This device is often called a cervical collar. Before this device is used the mechanism of the patient’s injury is considered. The patient’s history and signs or symptoms that may lead an Emergency Medical Technician to suspect a spinal injury are evaluated to determine if a cervical collar should be used. A cervical spine immobilization device usually has a posterior and anterior section that is made of stiff material. The two sides are usually connected by Velcro, with the anterior portion fitting the chin and chest. When the immobilization device is correctly worn, the patient should not be able to turn their head from side to side or up and down easily.
There are different sized cervical collars. A patient should use the size that fits them. Using a size that is too big or too small could cause additional injuries. If the device is too loose, the patient’s neck may not be supported enough allowing the patient’s head to move and cause further damage. If the device is too small, it could be too tight around the patient’s airway and cause an obstruction or allow the head to bend forward. A cervical collar should be placed so that the patient’s head can rest in a neutral position. The patients chin should rest comfortably in the chin rest. When the two sides are Velcroed together, the patient’s chin should be stable and the head should be in a neutral position.
An Emergency Medical Technician should always assess and size-up the scene before giving aid. This assessment should include identifying any possible mechanisms of injury. Once this is determined the EMT will find the patient. The state of responsiveness that the patient is in will determine the next steps that the EMT will take.
A responsive patient will be told not to move while the EMT asks questions to create a detailed focused history. While one EMT asks questions, another EMT can stabilize the patient’s cervical spine. The following are several important questions that trauma patients should be asked:
-What happened?
-Where does it hurt?
-Does your neck or back hurt?
-Can you move your toes and fingers?
-Where am I touching you now (while touching fingers and toes)?
The answers that the patient gives to these questions can give the EMT a good idea of possible spinal trauma. After these questions are asked, the EMT should inspect the patient for any deformities, contusions, abrasions, punctures, penetrations, burns, tenderness, lacerations, and swelling. The patient should be checked to see if the there is equal strength in the extremities. This can be done by having the patient grasp the EMT’s hands with his hands. The EMT will determine if the grasp strength is equal on both sides.
A responsive patient can provide the EMT with information about where there is pain, how he or she feels, and what happened. A responsive patient could become unresponsive at any time.
An unresponsive patient is a little more challenging for an EMT to assess because the patient is unable to communicate answers to trauma questions. The EMT will have to rely on observations to fill in any missing information that could have been obtained had the patient been responsive. The EMT should inspect vehicles and equipment involved as well as any injury sites on the patient.
An unresponsive patient’s head should be manually immobilized before a long backboard immobilization device is used. The EMT should always monitor the unresponsive patient’s airway, breathing and circulation and be prepared to treat the patient for any life-threatening conditions.
8
Patient Complications and Conditions to Blood Draw
0 Comments | Posted by admin in Uncategorized
Patients can experience a number of complications and conditions when blood is drawn. These complications can range from mild to severe.
Occasionally patients are allergic to one or more of the supplies used to for blood collection. Some patients are allergic to the glue used in the adhesive bandages. Some patients are allergic to the antiseptic used in the skin preparations before the blood is collected. An increasing number of patients are allergic to latex gloves that may be worn by the phlebotomist. Depending on the type of allergy, alternative bandaging materials, antiseptics or gloves should be available.
Most patients will stop bleeding within a few minutes of venipuncture. However, some patients, especially those who are taking aspirin or who are anticoagulant therapy, may not stop bleeding as quickly. After the venipuncture, pressure should be maintained on the site until the bleeding stops. Bleeding that continues for more than 5 minutes should be brought to the attention of a physician.
Fainting can result from insufficient blood flow to the brain. This condition can last anywhere from a few seconds to half and hour. Some patients are more sensitive to fainting and can faint at the thought or sight of blood. There are actual physical factors that can contribute to fainting. They include anemia, dehydration, emotional problems, fatigue, hypoglycemia, medications, nausea, and poor ventilation. If a patient feels faint, he or she should be asked to lie down for the procedure.
Nausea and vomiting are also common during or after a blood draw. If a patient feels nauseated or vomits before a blood draw, the draw should not commence until the patient feels better.
There are six elements that an Emergency Medical Technician (EMT) should obtain when gathering information about a patient’s medical problems. These elements can put help the EMT to determine an appropriate course of action when providing medical care. The acronym SAMPLE stands for the six elements that are to be documented.
Signs and symptoms, Allergies, Medications, Pertinent past medical history, Last oral intake, Events leading to injury or illness.
Signs and symptoms are the types of indications that are possibly evident of a problem. A sign is a medical condition or trauma that can be observed and identified in a patient. Skin color, temperature, blood pressure, pulse and bleeding are all signs that are commonly looked for when an EMT assesses a patient. A symptom is any nonobservable condition that is described by the patient. A patient may state that they feel sick, have a headache or feel nauseous. You can not see these symptoms and must rely on the patient to explain them to you. Signs and symptoms are important because they will help you to determine how to best care for the patient. If a patient is having a difficult time explaining symptoms, encourage him to explain the problem that caused him to call for emergency assistance.
It is very important to identify and allergies that a patient might have to medications, foods, or environmental factors. Medical alert bands are often worn by people who have serious allergic reactions to specific types of medications. Always look for a medical alert band before administering any medication to a patient.
Identify any medications that the patient is taking. If the patient is unable to provide this information personally then seek out a family member that may be able to provide this information. Determine if the patient takes over-the-counter medications, herbal treatments or prescription medications. Also ask about the dosage and frequency for each medication. Some patients do not comply completely with the dosage that is prescribed. You will want to know if the patient has been complying. Ask the patient or family members if the medications are being taken as prescribed and if the medications are on hand, check to see if they are current or recently prescribed.
A pertinent past medical history can be obtained by asking the patient about any past medical problems, surgeries, and injuries. You only want to document recent or pertinent medical history that is relevant to the patient’s chief complaint.
Documenting the last oral intake a patient had should also include the time and quantity of either solid or liquid food. This information is relevant incase emergency surgery is required.
Events leading to the injury or illness can provide valuable information and should be documented in the order in which they occurred.
