EMT- Five Rights of Medication Administration

What are the 5 rights of medication administration?  Why is it important to follow these rights every time that you go to administer a medication to the patient?  Also respond to 2 other students posts.

Five Rights of Medication Administration:

1.       Right Patient (Does this medication belong to the patient? Is this the same patient medical direction approved a medication order for?)

2.       Right Time (Have I made the right decision to administer the medication based on what I am seeing? Is it appropriate under these circumstances to give this particular medication?)

3.       Right Medication (Did I pick up the right bottle? Am I sure this is the correct medication?)

4.       Right Dose (Have I double checked? Am I sure I am giving the correct amount?)

5.       Right Route ((oral/swallowed, sublingual/dissolved under the tongue, Inhaled, Intravenous/injected into a vein, intramuscular/injected into the muscle, Subcutaneous/injected under the skin, intraosseous/injected into the bone marrow cavity, endotracheal/sprayed directly into a tube inserted into the trachea)

It is important to follow these rights every time I go to administer a medication to the patient because it is beneficial to the patient as well as the EMT administering the medication due to legal purposes from documentation. As simple and logical as these 5 Rights appear to be, one missed right could amount to a life. I understand the responsibility of needing to cognate the information given on the medication to determine the correct patient is being given the correct drug. It is easy to assume the patient will become more critical if given the wrong drug so right number one helps prevent the occurrence from happening. Timing has been a reoccurring stress, worry, theme, and topic of discussion in EMS because it is so critical. Time is irretrievable and therefore, highly important to consider when administering medication. Maybe the patient is stable and just having trouble breathing, but you know from their past medical history and the fact that they get short of breath when doing physical activity that they have cardiac distress. Although they might be stable at that moment, you should identify and apply their need for their current heart medication, nitroglycerin, aspirin, etc. to plan ahead of time before their condition descends. Choosing the right medication sounds simple, but I can imagine how it could easily be an issue due to most prescription medications being in similar orange bottles with labels. The correct dose administration of medication is essential. Some things to consider include the patient’s height and weight. If the patient is 100 pounds and 5 ft., then the drug will be more powerful and active in their body compared to a 300 pound man who is 6ft. 2in. The pill might need to even be split in half or diluted in water in order to properly treat the patient. Determining the correct route of medication into the patient is essential. You can’t be putting a pill intraosseously. It just doesn’t work that way. You need to not only use common sense, but be smart and read the label as well as the patient’s state. Some routes are more efficient, handy at that time, or create a stronger effect if done one route compared to another. It depends on the patient’s state and how the medication is supposed to be administered.

EMT- Trauma

You arrive on scene to a roll over car accident where a passenger has been thrown from the car and the driver is trapped.  The fire department has not yet arrived on scene, but the police are on scene.  People are starting to gather around both victims.  How should you handle the scene and who is a priority to take care of first?  Also respond to 2 other students posts.

In the case of a trauma such as this one given, I would wait until the scene and call for additional resources/back up while waiting for the scene to be safe and the crowd has been managed. I would be aware of traffic, ensure the ambulance is parked in the safest location, be observant of any glass, debris, broken power lines, spilled/leaking gasoline or fluids, etc. for the sake of me and my crew’s safety. My first priority is to ensure my safety and my next priority would be the patient evicted from the vehicle. I would make sure I have the appropriate  BSI worn properly (usually a helmet and vest). Then I would do a scene size-up as I mentioned earlier which would include determining whether or not the scene is safe, determining the MOI/NOI from the dispatcher and the observations made when pulling up to the scene, determining the number of patients (in this case two) which would then call for additional resources, ALS/EMS assistance, and bring the backboard for C-spine precautions (which are very much needed in this case, obviously.) I would medically tend to the patient evicted from the car while the firefighters are assisting the other patient/driver trapped in the car. For my primary survey, I would get a general impression of the patient and determine their alertness/ responsiveness. Since they were thrown out of the car, I would assume they are probably unconscious. At the same time I would do my ABCs and begin my Head to Toe body examination. First, cutting off the patient’s clothes then begin my Trauma Examination: Rapid Trauma Exam. While doing my trauma examination then I would be looking for DCAPBTLS (Deformities, contusions/bruises, abrasions/scraped skin, penetration/punctures, burns, tenderness, lacerations/cuts, and swelling). I would feel the head, check airway and ears patency, palpate trachea, chest palpitation down the center of the chest with my hands in the shape of a knife, check sides by pushing in to see if ribs are fractured, palpate the four quadrants of the stomach checking for distension and rigidity, place pals on inner hips while using my body weight to rotate the hips (aka: “open and close the book” motion), check broken bones by palpating with alternating pressure down the arms and legs, checking pulses both palmer and radial, turn on back while stabilizing spine with EMT partner to check for any step-offs, chepidice (not sure if I spelt it right, but it’s bone on bone), and palpating/inspecting the thorax, lumbar, and buttocks areas. , etc. Since the patient is unconscious, then I’d check for any medical/sample history by checking their wallet, pockets, and/or purse or bags (essentially any available resources) to see if the patient has any allergies, essential medical history that could be valuable when treating them, etc. I’d check for vital signs and tend to any wounds or secondary injuries properly while stabilizing the patient. I would choose to load and go while reassessing my patient every five minutes. The patient should be on oxygen and cared for appropriately with whatever their condition is at that time. As for the patient who was the driver, the firefighters would hopefully be trying to get the patient from out of the car to a safer area on scene. That would allow myself, my partner, or any other back up team to medically tend to that patient. I would assist them in the same procedure (Rapid Trauma Exam most likely) like I had with the patient evicted from the vehicle. If the scene was safe enough for me to help the patient in any way I could while they were trapped in the car, then I would, but only if it was safe enough. There are several things to consider when approaching a tumbled car like leaking fluid, possible random explosion, fire, etc. that would all need to be taken into account to ensure my safety. It would be desirable that the scene is safe enough to medically service the patient and do everything I could, while ensuring the safety of myself, my crew, and others, to help the patient medically and emotionally. 

EMT- Scene Safety and Scene Size-Up

When doing a scene size up, when should you call for help and what are three possible reasons you will need additional help?  What are some ways to determine the mechanism of injury and what type of injuries will there possibly be to take care of?  Also respond to 2 other students posts

An EMT should call for help when doing a scene size up if he/she thinks they will need additional resources like an ALS unit for more serious calls or a medical emergency concerning more than one patient. MOI and NOI is the information given to the EMT concerning the patient which gives the EMT a heads up as to what they will be expecting so that they can prepare. Some ways they will prepare include determining whether or not they will need to call for additional resources/back-up or whether or not to bring a backboard for C-Spine precautions. Some possible reasons the EMT will need additional help would include a multiple casualty incident, medical and trauma calls, if the scene is unsafe due to animals, gas leakage, fire, outraged family members, and just anything that could be hazardous/unsafe to the EMS crew,  (the scene should be safe anyway, but in the case that it isn’t, then you would need to call for scene safety/police), and/or in the case the patient is stuck in machinery and you’d need another professions with expertise in that field of area to help lift, move, or detach that industrial machinery such as a firefighter. Some ways to determine the mechanism of injury (MOI) include being given the information by the dispatcher before you arrive on scene, observing/analyzing the scene while driving/pulling up in the ambulance, and just in your overall scene size up. Some types of injuries that might be there to take care of include a patient in cardiac distress complaining of chest pain (put ALS on standby), patient with their hand stuck in a machine (need for firefighters), anxiety calls, shortness of breath patients, lacerations, burns, cuts, etc. There maybe cases when the EMT may need to call for backup once actually on scene with the patient, but the point of scene size up and MOI/NOI is to prepare so that the patient is in the best care with all the correct staff and resources to help them.

EMT- Oxygen Administration

Two conditions that would require oxygen could include:

1.Cardiac Arrest:

-The patient is unconscious and is not breathing, but has a slight pulse. At this point, the body has about 5% Oxygen available which could last about 5 minutes. By the time the EMT arrives, they will need to start compressions which will circulate the oxygen in the body. While doing the compressions, the EMT should maintain correct form with knees by the patient’s side, arms/elbows straight, overlapping hands just above the nipples towards the median, and performing compressions with full recoil of about ½ the diameter of the patient’s torso. They must follow the 30/2 ratio performing 30 compressions with 2 pumps oxygen with the Bag-Valve-Mask (BVM) until the AED is available and ready for activation. Once the AED is placed properly on the patient, then it will stop the heart and any abnormal electrical activity in hopes the body will restart with a regular, stable beating rhythm. Before performing compressions and using the BVM, then the EMT should look to make sure the airway is patent. This could explain why the patient isn’t breathing. For example, maybe the patient choked and that is how they became unconscious, but not in this case. The EMT should also look at the chest and stomach for breathing, listen for breathing, and feel the patient’s pulse. Throughout the EMT’s procedure, they should be examining vital signs to see if there is any progress in the patient’s health.

2.Anxiety

-In the case of anxiety, the patient is experiencing a rapid heart rate which is resulting in limited Carbonic Acid that is supposed to be in the body. If the patient’s respiration rate is above 40/minute, then it is appropriate to use the BVM. By using the Bag-Valve-Mask (BVM), the EMT can force Oxygen and slow the breathing to a breathing pattern appropriate (12-20/minute). While using the BVM, the EMT should talk the patient through the procedure to calm the patient down and communicate that they will be forcing them to take bigger breaths by using this BVM mask and to breathe when instructed in hopes of achieving deeper breaths.

In order to provide an open airway, the EMT can use the Head-Tilt Chin Lift or the Jaw Thrust. The Head-Tilt Chin Lift can be performed on normal patients that aren’t experiencing any trauma like spinal injury, for example. However, the Jaw Thrust is designed specifically for trauma patients to ensure the correct posture of the patient without having to move the neck. 

EMT- Different Phases of Life- Compare and Contrast

It was eye opening getting a more educational, analytical perspective on the similarities and differences between the Toddler Phase (ages 12-36 months) and the Adolescence Phase (ages 13-18 years).  As an 18 year old, I could relate to the characteristics, both physiological and psychosocial. Then, reading about the Toddler Phase, I grew somewhat quite. It was humbling understanding that this age is understood by science to be known as an age of development in mental, emotional, and physical maturity, much like 12-36 month olds. Teenagers commonly develop an image with the purpose of being “popular,” “cool,” and/or different from all other stages in life. We’ve even developed a language of slang, text lingo, etc. that is visualized by society as a completely different stage in life compared to all others. What I found was, despite the obvious differences between toddlers and adolescent teens, teenagers aren’t so advanced and act/grow very much like babies. It’s a very self-consumed age for toddlers and adolescent teenagers.

Toddler and Adolescence Similarities & Differences:

*Experience Rapid Growth

-Toddlers:

-grow 4.4 pounds/year

-systems develop and advance: pulmonary (airways grow and alveoli increases), nervous system (90% development of brain/develop motor skills), musculoskeletal (muscle mass and bone density increase), immune system (becomes more resistant/stronger), teeth (have all primary teeth)

-Adolescence:

                -growth spurt lasting 2-3 years (girls done by age 16 and men by age 18)

                -reach reproductive maturity

-heart rate: 55-105/minute, respiratory rate: 12-20/minute, systolic blood pressure: 80 120mmHg

*Body Temperature

-Toddlers:

                -96.8-99.6 Degrees Fahrenheit

-Adolescence:

                -97.8-99 Degrees Fahrenheit

*Develop own Individuality:

-Toddlers:

-As Toddlers are developing their physical strength and new body form, they become more curious and want to become more adventurous. They are often times called “curtain climbers” or “rug rats” due to this curiosity that results in “occasional” mischief (aka: “terrible twos” stage).

-Adolescence:

-Teenagers develop their individuality or identity through curiosity, as well. However, their curiosity sometimes results in home conflict with parents/guardians, self-destruction, drugs, sexual curiosity/identity, etc. As they crawl closer to Early Adulthood, they desire more independence. Toddlers may find their independence through crawling away or wanting to explore the backyard, but adolescent teens strive for independence, usually from their parents.

*Increasing Cognitive Development

-Toddlers:

-Toddlers are developing their understanding of cause and effect. By 12 months, toddlers will begin to grasp what words actually “mean” by putting names with faces, for example. From 18-24 months, toddlers begin to understand cause and effect like when they are dropped off at daycare, they understand their mom is leaving and will develop separation anxiety. (Total opposite of teens who want less time with their parents, normally). 24-36 month olds begin to be more creative and by 3-4 years old, they have basic language down.

-Adolescence:

-Teens are developing their cognitive skills more and more, but in a different way that prepares them for Early Adulthood which includes college, work, responsibilities, etc. They are understanding the consequences of their actions through cause and effect which is explanatory for the obvious tension and constant disapproval between parent and teen. Teenagers are learning abundantly through their high school experience (hopefully) in preparation of flying off into a suited life stage requiring more responsibility and are applying those morals and themes learned through life actions/experience and interpreting/applying those principles as their maturity progresses. 

EMT Stress Management Discussion Question

Knowing the causes of stress will help the EMT understand how to handle the various levels of stress that they will encounter.  List 1 of the causes of stress and the ways to handle it. Also respond to 2 other students posts about other ways to handle the stressful situation that they identified.  Use your own experience in dealing with stress.

One of the causes of stress is the scarcity of time. EMTs are expected to report to the medical emergency within minutes. Upon arrival, time is sacred in using the educational knowledge and training to the best of their abilities. There isn’t any time to forget which tool to use or how to use it, ask for a break so you don’t vomit in response to the amount of blood from the patient, or try and remember where the switch is on the machine, for example. I have volunteered for the hospital for four years and participated as an intern for Marian Medical’s Physician Mentorship Program. I remember observing a gastrointestinal surgery and watching the blood squirt into the air and onto the surgeon’s mask. This was a common surgery that he had done several times before and felt prepared, but in this one instance, something went wrong. There wasn’t time to clean up or wash off, there was only time to find the source of bleeding and provide compression, etc. There are ways to prepare for the job; however, sometimes preparation is necessary even for the most common tasks which is important to remember. In times of stress, like when the patient won’t stop bleeding out, or blood comes in contact with your eye, etc., then it’s important to stay calm, assess the situation, and perform accurately and attentively.

                My personal experience in dealing with stress stems from my sister’s Severe Crohn’s Disease. I remember when my sister was in surgery (this one out of the hundreds of others she has had) and hearing the doctor tell my parents we needed to say our goodbyes because her condition was critical. It was at that moment that I understood the responsibility of stress management. I was five years old, wanting to cry, but I knew that I needed to stay calm and be supportive of my parents as it was their daughter that was dying. Selflessness, sincerity, compassion all came along with dealing with stress. I responded to that stress by referring to prayer and remembering my priority here on Earth; to serve God and others.

                Time is precious and therefore makes for stressful situations. It causes EMTs to be better at their jobs by making it a necessity to prepare for the worst and be educated. Ways to deal with stress in these timely circumstances is by preparing, as an EMT, whether it be studying an EMT text book while off-duty or waiting for a call, communicating with other EMTs concerning your emotional suffering/stress, exercising so that time won’t have to delay based off of poor physical health, and/or participating in spirituality whether it be worship, prayer, meditation, confession, etc. as a form of expression and as an outlet.  

                 

EMT Personal and Physical Characteristics Discussion Question

EMTs should possess enumerated skills due to their medical intervention and attention among society. Personal and physical traits vary significantly including being pleasant, sincere, cooperative, resourceful, a self-starter, emotionally stable, leadership, neat and clean, moral/respectful character, control of personal habits, communication/listening skills, physical strength, etc. Considering the statistics, the U.S. had around 58 documented fire/EMS suicides in 2014 (likely only a fraction of the actual count, according to the Statistician). Therefore; I conclude the most important traits as an EMT would go as followed (3 personal, 1 physical):

1.       Cognitive/Analytical/Observational Skills: ability to process information, reason, remember, and relate new information to medical knowledge to be able to perform medical duties.

-There isn’t a statistic needed to say that 100% of the job requires this skill. Upon arrival, the EMT is required to observe the surrounding environment, thus acquiring information plausible to make a personal diagnosis of the patient and prepare. Identifying and familiarizing the setting could mean for better resourcefulness, as well. This awareness is carried through to the connection with the patient. It is essential to identify and analyze the many vital signs signifying the patient’s current state of being. Once all observations and information is acquired, then comes decisiveness. “Which hospital should we bring the patient to?” For some cases, this decision could mean life or death. If the patient is in critical condition, then the EMT is required to decide, by the use of his cognitive skills, whether to bring the patient to a specialty hospital even though it could mean a longer drive or transport the patient to a general hospital that might not have the purposeful supplies needed to better care for the patient, but could save precious time, for example.

2.       Communication Skills: able to convey information to people clearly and simply, in a way that means things are understood and get done. It's about transmitting and receiving messages clearly, and being able to read your audience.

-Communication skills are essential in all aspect of life and the global workforce whether it be through verbal words, physical touch, literary communication, eye contact, etc. Communication comes in many forms. EMTs have the responsibility to acquire appropriate communication skills whether it be asking questions concerning the patient’s current state, writing down medical documentation, contacting a doctor for further guidance, making eye contact with other drivers on the road while operating the ambulance, and/or in unfortunate circumstances, informing the family that their loved one, communicated by name, that they have died. Not only does this apply during the course of action taken to medically assist patients, but in assisting the EMT themselves. Talking about emotional distress concerning EMT employment can be a stress reliever. An EMT will be better able to medically assist if they are at a healthy state themselves.

3.       Stable/Static Physical Health and Wellness: physically fit to carry out duties as an EMT involving coordination, flexibility, strength, dexterity, etc.

-It is obvious to say that an EMT is expected to be appropriately physically fit in the case needed to carry a 200 pound human, for example. However, with the physical support and teamwork of your co-workers on cite, the physical aspect of the job should be somewhat controlled, predetermined, and realistic/doable. What are commonly overlooked and taken for granted are the importance of eyesight while performing EMT duties. Color vision can be used to identify vital signs such as skin color, for example. You also need to be able to easily see the written instructions and identify machinery for use in the proper fashion. Hearing is essential while driving the ambulance, obtaining information from the patient and society, instruction, etc. Our vital signs are important in identifying other’s vital signs which makes them extremely important in being able to carry out the job.

4.       Correct balance of Teamwork/Leadership: combined action of a group of people, especially when effective and efficient. Leadership: the action of leading a group of people or an organization.

-Direction, cooperation, management, control, etc. are all part of this job. Leading in the sense of taking necessary guidance to control a scene, organize crowds are essential in emergency medical care for the well-being and safety of the patient, yourself, and the rest of society. Teamwork allows for a more efficient approach to care and establishes confidence in the patient and society who are overseeing that all medical staff on duty is using their knowledge combined to better provide for their friend or loved one suffering.