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 Along with the dispensing of medications comes the responsibility to learn as much
as possible about the medications.
 The danger of something going wrong when administering a drug—for example,
administering the wrong drug or the wrong dose of a drug—can be minimized by
confirming the “six rights” of medication administration: right patient, right drug,
right dose, right route, right time, and right documentation.
 Follow a set procedure when you administer any medication. A safe procedure begins
with obtaining an order from medical control and making sure you understand the
physician’s orders. Repeat any orders word for word for verification.
 You must inquire about any medication allergies that the patient may have. Verify the
proper medication and prescription. Verify the form, dose, and route of the
medication.
 You must also check the expiration date and condition of the medication before its
administration and confirm medication compatibility.
 The final steps of medication administration are to notify the physician when the
medication has been administered, monitor the patient for effects, and advise medical
control of any changes in the patient’s condition. Document your actions and the
patient’s responses.
 Dispose of any syringes and needles safely in a sharps container, and do not recap
needles.
 A certified AEMT is allowed to administer or help patients self-administer numerous
medications: oxygen, oral glucose, glucagon, 50% dextrose, epinephrine, metereddose inhaler medications, nebulized medications, nitroglycerin, nitrous oxide,
naloxone, aspirin, and possibly others based on local protocol.
 AEMTs may administer intravenous (IV) fluids, including 5% dextrose in water
(D5W), normal saline, and lactated Ringer’s solution.
 AEMTs may only administer medications and fluids when either directly ordered by
medical control or allowed by local protocols or standing orders.
 An understanding of basic cell physiology can help an AEMT understand why
different types of IV fluids are administered for different conditions. The cellular
environment contains ions, or electrolytes, that are used by the cell for different
purposes, depending on its needs. These ions include sodium, potassium, calcium,
bicarbonate, chloride, and phosphorus. Their electrical charges must remain in
balance on either side of the cell membrane.
 There must be a balance of compounds on either side of the cell membrane. If an
imbalance occurs, the cell can move chemicals or charges across its membrane by
various methods, including diffusion, filtration, active transport, and osmosis.
 Becoming familiar with the various types of IV solutions will give you an
understanding of their use in relation to patient conditions. IV solutions are
categorized by dissolved components (crystalloid and colloid) and by tonicity
(isotonic, hypotonic, hypertonic).
 Crystalloid solutions are dissolved crystals in water, and contain compounds that
quickly disassociate in solution. These solutions are the best choice for the patients
who need fluid replacement.
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Colloid solutions contain molecules that are too large to pass out of the capillary
membranes and therefore remain in the vascular compartment. These are not
generally used in the prehospital setting. Examples of colloids are albumin and
corticosteroids.
Isotonic solutions have nearly the same osmolarity as serum and other body fluids;
therefore, these solutions stay inside the intravascular compartment. Hypotonic
solutions have a lower concentration of sodium than the cell; these solutions pull fluid
from the vascular compartment into the interstitial fluid compartment. Hypertonic
solutions have a higher osmolarity than serum, and shift fluids into the intravascular
compartment.
Successful IV administration technique takes practice. Several factors, from the
patient’s condition to the available IV equipment, influence every IV start. Mastery of
IV therapy skills comes when you understand and can overcome all the variables.
Take your time when you practice inserting an IV line and gain a solid understanding
of what you are doing. This understanding will be useful when you need to start a
quick and flawless IV line in less than optimum conditions.
During IV therapy, it is critical to always keep equipment sterile.
You will need to choose an IV solution and administration set. There are different
sizes of administration sets for different situations and patients. Administration sets
come in two primary sizes: microdrip and macrodrip. Microdrip sets are ideal for
medication administration; macrodrip sets are best for fluid replacement.
Before administering IV fluid, you will need to choose an IV site, spike the bag, and
choose a catheter. Catheters are sized by their diameter and referred to by the gauge
of the catheter. The larger the diameter of the catheter, the smaller the gauge. The
larger the diameter, the more fluid can be delivered through the catheter.
Once you have gained vascular access, you will need to secure the line and remove
the constricting band.
Possible complications of IV therapy include local reactions and systemic reactions.
Infiltration is the escape of fluid into the surrounding tissue. This escape of fluid
causes a localized area of edema. To correct the infiltration, discontinue
administration and reestablish an IV line in the opposite extremity or at a more
proximal location on the same extremity. Apply direct pressure over the swollen area
to reduce further swelling or bleeding into the tissue.
Occlusion is the physical blockage of a vein or catheter. If the flow rate is not
sufficient to keep fluid moving out of the catheter tip and if blood enters the catheter,
a clot may form and occlude the flow.
A hematoma is an accumulation of blood in the tissues surrounding an IV site. Blood
can be seen rapidly pooling around the IV site, leading to tenderness and pain. If a
hematoma develops while you are attempting to insert a catheter, stop and apply
direct pressure to help minimize bleeding. If a hematoma develops after a successful
catheter insertion, evaluate the IV flow and the hematoma.
Any allergic reaction must be treated aggressively. Patient presentation depends on
the extent of the reaction. If an allergic reaction occurs, discontinue administration
and remove the solution. Notify medical control immediately and maintain an open
airway.
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Treat a patient with a suspected air embolus by placing the patient on his or her left
side with the head down to trap any air inside the right atrium or right ventricle and
rapidly transport to the closest most appropriate facility. Be prepared to assist
ventilations if the patient experiences increasing shortness of breath or inadequate
tidal volume. Document the event.
Catheter shear occurs when part of the catheter is pinched against the needle, and the
needle slices through the catheter, creating a free-floating segment. Treatment
involves surgical removal of the sheared tip.
An unmonitored IV bag can lead to circulatory overload. Always monitor IV bags to
ensure the proper drip rate. To treat a patient with circulatory overload, slow the IV
rate to keep the vein open and raise the patient’s head to ease respiratory distress.
Administer high-flow oxygen and monitor vital signs and breathing adequacy.
Contact medical control immediately and document the event.
Administering IV therapy to pediatric and geriatric patients requires special care.
Both populations are at a higher risk for certain medical conditions that can affect
both the patient’s need for IV therapy and the effectiveness of the therapy. By
understanding the risks and concerns of these populations, you will be better
equipped to properly administer IV therapy. Finally, in any medical situation
involving pediatric or geriatric patients, remember to be sensitive to the patient’s
personal issues.
Good math skills, along with an understanding of the metric system, are imperative to
providing the correct dose for the patient. Practice your math skills frequently to stay
proficient.
As an AEMT, you should be familiar with the various routes of medication
administration. This includes an understanding of the proper use of equipment and
proper anatomic locations for administration. Enteral administration includes the
administration of all drugs that may be given through any portion of the digestive
tract. The parenteral route includes any method of drug administration that does not
go through the digestive tract.
When in doubt, always follow local protocols or contact medical control for direction.