EMT-Bs and IV therapy

[zmedic]

I think people are forgetting that often these EMTs are working with a medic. I used to work in CO and had my IV cert. It wasn't a matter of me running around doing fluid therapy on my own. But rather I was legally allowed to start a line while my paramedic partner was pulling up drugs, doing assessment etc. It worked great because it meant that we could run a code just with a medic and and EMT and someone (FF) to do compressions. It's a lot cheaper for the system to have a medic and and EMT who can start a line and put on a 12 lead then to run double medic trucks.

The medical director can decide that they don't want their EMTs doing fluids even if they have the cert, but it's nice to have for those systems where you can use it. And it's a lot easier to put all your EMTs through a 24 hour EMT class then demand that they call got their EMT I. (IV cert was a requirement of the company I worked for.)

 

[ExpatMedic0]

Shoot, I knew all that theory stuff back in school, now it's just "poke and push"

haha +1

 

[JPINFV]

Shoot, I knew all that theory stuff back in school, now it's just "poke and push"

 

[MrBrown]

I knew all that stuff in school and *gasp, I still know it!

 

[EMTSTUDENT25]

Here in TN(nashville) we are trained in IV therapy within the first month of class, and were required to get at least 5 sticks on our clinical rides and ER shifts. We are also able to administer glucagon IM and D5W IV. With that being said however, its up to the county or service whether or not they even allow their EMT's to start IVs. I know for sure that some dont. There are only so many techniques and tricks to learn about getting a successfull line in place. Ive seen RN's and Medics struggle. Im no expert considering i havent done many myself, but their not always easy from what ive witnessed.

 

[bstone]

EMT's to start IVs.

Why is EMT with an apostrophe and IV isn't? Sorry, just confused.

 

[medicRob]

Here in TN(nashville) we are trained in IV therapy within the first month of class, and were required to get at least 5 sticks on our clinical rides and ER shifts. We are also able to administer glucagon IM and D5W IV. With that being said however, its up to the county or service whether or not they even allow their EMT's to start IVs. I know for sure that some dont. There are only so many techniques and tricks to learn about getting a successfull line in place. Ive seen RN's and Medics struggle. Im no expert considering i havent done many myself, but their not always easy from what ive witnessed.

EMT-IV (i/85) has worked out quite well for Tennessee. In Fall 2011, EMTSTUDENT25 you will be given the option to take a bridge course to
emt-Advanced or revert to EMT-B, you will gain the ability to administer nitrous, EZ IO, administer narcan, and a few other things. The state is still finishing up on the gap analysis.

 

[medicRob]

Why is EMT with an apostrophe and IV isn't? Sorry, just confused.

EMT shouldn't have had an apostrophe nor should IV. IVs and EMTs, that would be the proper way to pluralize those terms, although neither is a word, they are abbreviations. However, you would not say, "Intravenous's", so the argument falls apart all together.. damn abbreviations.

 

[JPINFV]

Abbreviations are always funny. Technically just leaving "IV" at "IV" is stupid. Hey guys, I just started an intravenous!" Really? Intravenous what? However starting an "IV line" or "IV lines" makes perfect sense.

 

[medicRob]

Abbreviations are always funny. Technically just leaving "IV" at "IV" is stupid. Hey guys, I just started an intravenous!" Really? Intravenous what? However starting an "IV line" or "IV lines" makes perfect sense.

I ran 2 large bore Intravenous's normal salines TKOs over a period of 2 hours.

.. yeah, that sounds about right.

 

[JPINFV]

i ran 2 large bore intravenous's normal salines to keep opens over a period of 2 hours.

.. Yeah, that sounds about right.

ftfy.

 

[EMTSTUDENT25]

My apologies with my horrible grammer. Ha! MedicRob-my instructors spoke of this "advanced" option, will this consist of a couple classes teaching the new drugs and then a test at the end? Just wondering because they wernt too specific on how the process was going to work.

 

[8jimi8]

Out here in Colorado EMT-Bs can take a quick and dirty course (mine was about 24 hours lecture with an 8-16 hour clinical rotation, some are shorter) to get "IV approval" allowing them to start peripheral IVs and administer crystalloids such as normal saline and lactated ringer's as well as D50 and Narcan (curriculum teaches intranasal admin but medical directors may allow for IV narcan admin).

Any opinions on this? I just completed the course but still need to do my clinical rotation. I've gotten 5 or so successful sticks on other students in class, but I'm pretty nervous to stick a patient.

I haven't read any of the responses, this is my gut reaction to reading the OP.

you should be nervous to kill, or infect a patient. Do you really think you understand fluid dynamics, hemodynamics and all of the complications that can arise from intravenous therapy? Do you know what cerebral perfusion pressure is? Do you know what IICP is? Do you know the difference between the sound of pneumonia and fluid overload?

these are not questions to intimidate or be mean to you. i just dont think that basics should be administering IV fluids.

With the caveat being: Allow the basic to instill no more than 30 cc of 0.9%N.S. that gives you 10 cc for the iv insertion, and 10 before and after you draw some labs off the new line.

And really, i might actually only be th inking i'd be ok with You doing that, Lucid, even though I don't know you IRL, i trust that you are truly at heart a patient advocate and not just a skill monkey chasing interventions. I haven't met very many other basics that I'd trust with IV therapy.

 

[medicRob]

My apologies with my horrible grammer. Ha! MedicRob-my instructors spoke of this "advanced" option, will this consist of a couple classes teaching the new drugs and then a test at the end? Just wondering because they wernt too specific on how the process was going to work.

They didn't really specify that at the directors conference when they announced it. They just said that they are still in the process of getting things ready. They are looking to give EMT-IV up to 2 renewal periods to take the course, before being forced to become an EMT-B again. I am thinking it will be like our current EMT-B to IV Bridge course, consisting of 4 credit hours. The NREMT won't be hosting a test for EMT-Advanced until 2014 according to the newsletter, so I assume all current EMT-IV will become Advanced that take the test and we wont see any initial advanced classes until sometime around Fall 13.

 

[CAOX3]

If your system allows this in a PB system I dont see a problem with it.

In general I dont see the point of a double basic truck needing IV access. Never been on scene and thought to myself "Hmmm I wish I could put an IV in this person."

 

[8jimi8]

Until you can answer me the following, I am not allowing you to cannulate and infuse:

Fluid Balance
• Define the boundaries of each of the three fluid compartments and state the proportional volumes typically found in each

• Define the terms: electrolytes, ions, cations, anions. Give examples of each found in the body, and state their physiological functions. (half page)

• Define the term non-electrolyte and give three examples

• Give a brief explanation of the following electrolyte disorders. Include signs and symptoms that may manifest as a result of these.
o Hyponatremia
o Hypernatremia
o Hypokalemia
o Hyperkalemia

• Explain the initial fluid shift that would occur if the if the patients blood volume was suddenly reduced under Starlings Law.

• Define the following terms and explain the role each process plays in human fluid dynamics.
o Diffusion
o Osmosis
o Active Transport
o Facilitated Diffusion

• Define the following terms
o Shock
o Perfusion
o Inotropic
o Chronotropic
o Pulse Pressure
o Mean arterial pressure (MAP)

• Explain these complications of irreversible shock and how we may pre• vent and help treat them.
o Renal Failure
o Acute Respiratory Distress Syndrome (ARDS)
o Disseminated Intravascular Coagulation (IDC)

• Describe the pathophysiology, common presentation and briefly outline the management of distributive, cardiogenic and hypovolaemic shiock

• Discuss the differences between how children and adults (particularly the aged) maintain and respond to blood pressure changes

• Provide a definition of the peripheral resistance and stroke volume

• What factors about a blood vessel determine its peripheral resistance?

• During exercise stroke volume will increase. How is that achieved?

• Explain why fluid tends to shift from the interstitial to intravascular space in the early stages of shock.

• Blood transports a number of substances around the body. What are those substances and how are they transported in the blood

• Pulse Oxymetry measures the oxygenation of the blood flowing through the capillary beds and peripheral tissues. Explain how this concept works and when the use of pulse oxymetry is not indicated and why?

• Define isotonicity, hypertonicity and hypotonicitiy

List the constituent of various IV fluids and there respective tonicity.
o normal saline
o 0.45% NaCl
o 5% Dextrose
o Hartmanns

Homeostasis Regulation

• Explain the Renin-angiotensin pathway and explain how homeostasis of blood pressure and volume is maintained.

• Describe how the kidneys regulate the excretion of water in urine, and the role of the hormones ADH, and Aldosterone

Acid / Base Balance

• What is the normal pH range of body fluids?

• Define the term buffer system and list the 3 major buffer systems involved in acid / base balance

• Briefly describe the renal and respiratory compensatory mechanisms of acid/base balance

• A person presents with hyperventilation syndrome, classic signs of carpopedal spasm, peri-oral parasthesia. Explain the physiology that results in these signs and symptoms.

Trauma

• Explain the difference between blunt trauma and penetrating trauma, the difference in the types of injuries commonly encountered and their MOI (mechanism of injury) and the difference in the management of shock occuring as a result of each.

• Describe causes of shock, other than hypovolaemia, in trauma patients, and how to recognize and manage them.
o Tension pneumothorax
o Myocardial contusion
o Acute Myocardial Infarction
o Spinal injury

• Explain the shock management of this patient (on your 20min ride to hospital) with this head injury?
o B.P - 80/30
o Pulse – 128
o Resps – 28
o GCS - 13

IV Cannulation and Complications

• Indicate the anatomical location of common cannulation sites

• Discuss and explain factors that influence choice of vein for cannulation

• Intravenous cannulas are colour coded. List the colour, gauge and flow ware of various sized IV cannulas.

• Define ‘aseptic technique’ and explain universal safety measures taken while cannulating.

• Describe and discuss the concept of ‘informed and implied consent’.

• When gaining informed consent. List the information that you would inform the patient. (6234 – P.C 3.4)

• Prior to the administration of I.V fluids to a patient what checks should you perform? (6231 – P.C 4.4)

• State the clinical procedure for administering IV fluids to the shocked patient.

• List the signs and symptoms of the three IV complications below.
o Infiltration
o Phlebitis
o Extravasation

• For the following complications of IV cannulation describe the signs and symptoms and management of each.
o Fluid Overload
o Air Embolism
o Catheter Shear

yes.. +1 and add delete my original response.

 

[EMTSTUDENT25]

thanks for the positive response medicrob! i was starting to think that we were all on this forum for the wrong reasons! Im just a lil emt trying to learn a few things and dont claim to have all the answers...some of these members lil power hungry...

so not sure if this is the right area for this but: starting out, are emts just the ?go get this person?" are they "retrained" for the real world once they get with a certain service? just curious how its gonna be...

 

[medicRob]

thanks for the positive response medicrob! i was starting to think that we were all on this forum for the wrong reasons! Im just a lil emt trying to learn a few things and dont claim to have all the answers...some of these members lil power hungry...

so not sure if this is the right area for this but: starting out, are emts just the ?go get this person?" are they "retrained" for the real world once they get with a certain service? just curious how its gonna be...

Here in Tennessee, on your EMT-IV clinicals you will ride as the third person on the ambulance during clinicals and have the ability to perform any skill you are checked off on. Once you take your NR exam and your state EMT-IV license is processed, you will then go through the hiring process. The hiring process usually consists of an agility test, driving record, criminal background check, physical, and drug test and typically a few pre-employment ride alongs.

Once the decision to hire you has been made, you will usually ride with a senior EMT-P or a Field Training Officer until they feel comfortable enough to sign off on you and let you out on your own. The length of time this will take is all on you. Once you are with a service, you will be expected to attend a certain amount of mandatory in services such as NRP, King LT training, BTLS, PHTLS, etc as the service and your medical director sees fit. Moreover, you will be expected to complete a minimum amount of continuing education hours every 2 years by the state before they will allow you to renew your licensure. Most of us get our CEU's through EMS in services OR attending EMS Night Out with our local HEMS services.

 

[LucidResq]

I haven't read any of the responses, this is my gut reaction to reading the OP.

you should be nervous to kill, or infect a patient. Do you really think you understand fluid dynamics, hemodynamics and all of the complications that can arise from intravenous therapy? Do you know what cerebral perfusion pressure is? Do you know what IICP is? Do you know the difference between the sound of pneumonia and fluid overload?

these are not questions to intimidate or be mean to you. i just dont think that basics should be administering IV fluids.

With the caveat being: Allow the basic to instill no more than 30 cc of 0.9%N.S. that gives you 10 cc for the iv insertion, and 10 before and after you draw some labs off the new line.

And really, i might actually only be th inking i'd be ok with You doing that, Lucid, even though I don't know you IRL, i trust that you are truly at heart a patient advocate and not just a skill monkey chasing interventions. I haven't met very many other basics that I'd trust with IV therapy.

First of all I'd just like to point out I made the initial post over 2 years ago. I never even completed my IV approval. But it is standard in CO and it is almost impossible to get an EMT job without it. If they hire you without it, they will put you through it. That's just the way it is around here.

Me... yes I do know what cerebral perfusion pressure is, ICP, and a bit about hemodynamics and such. Unlike most EMTs out here, I've actually taken anatomy, physiology and several other relevant classes. You'll note though that I said "unlike most EMTs out here" which I find terrifying, honestly. That even without a background in A&P or any other real education/training, an EMT can be administering fluids and such drugs after a 24 hour crash course that focuses on the act of inserting an IV cath more than anything else.

 

[8jimi8]

First of all I'd just like to point out I made the initial post over 2 years ago. I never even completed my IV approval. But it is standard in CO and it is almost impossible to get an EMT job without it. If they hire you without it, they will put you through it. That's just the way it is around here.

Me... yes I do know what cerebral perfusion pressure is, ICP, and a bit about hemodynamics and such. Unlike most EMTs out here, I've actually taken anatomy, physiology and several other relevant classes. You'll note though that I said "unlike most EMTs out here" which I find terrifying, honestly. That even without a background in A&P or any other real education/training, an EMT can be administering fluids and such drugs after a 24 hour crash course that focuses on the act of inserting an IV cath more than anything else.

LOL like i said i didn't read any of the posts in my original reply. i also apparantly didnt read the date of the original posting. i wouldnt have noticed unless you pointed it out either! haha