EMS Pathophysiology - Anemia

Anemia is a condition marked by a reduction in the number of red blood cells (RBCs) or hemoglobin, impairing the blood’s ability to carry oxygen.

Recognizing and understanding the different types of anemia is crucial for EMS Providers, as this knowledge can guide appropriate prehospital care and improve patient outcomes.

Key Types of Anemia

* Iron Deficiency Anemia

• Cause: Inadequate iron intake or absorption, blood loss.

• Characteristics: Microcytic (small) and hypochromic (pale) RBCs.

• Symptoms: Fatigue, weakness, pallor, shortness of breath

• EMS Considerations: Assess for sources of bleeding (e.g., gastrointestinal), monitor vitals, consider oxygen therapy if indicated.

* Vitamin B12/Folate Deficiency Anemia

• Cause: Insufficient dietary intake or absorption of Vitamin B12 or folate.

• Characteristics: Macrocytic (large) and normochromic (normally colored) RBCs.

• Symptoms: Fatigue, glossitis (inflamed tongue), neurological symptoms (e.g., numbness, tingling).

• EMS Considerations: Assess neurological status, provide supportive care, monitor for signs of severe anemia.

* Hemolytic Anemia

• Cause: Increased RBC destruction due to autoimmune disorders, infections, or genetic conditions like sickle cell disease.

• Characteristics: Increased reticulocyte count (immature RBCs), jaundice.

• Symptoms: Fatigue, jaundice, dark urine, pain (especially in sickle cell crises).

• EMS Considerations: Pain management (especially for sickle cell crises), hydration, oxygen therapy, rapid transport for severe cases.

* Aplastic Anemia

• Cause: Bone marrow failure leading to decreased production of RBCs, white blood cells (WBCs), and platelets.

• Characteristics: Pancytopenia (reduced levels of all blood cells).

• Symptoms: Fatigue, frequent infections, easy bruising, bleeding.

• EMS Considerations: Monitor for signs of infection or bleeding, avoid invasive procedures when possible, supportive care, rapid transport.

* Anemia of Chronic Disease

• Cause: Chronic infections, inflammatory diseases, malignancies.

• Characteristics: Normocytic (normal size) and normochromic (normal color) RBCs, often with low iron availability.

• Symptoms: Fatigue, weakness, symptoms related to the underlying chronic condition.

• EMS Considerations: Assess and manage symptoms of the underlying condition, provide supportive care, monitor vitals.

General EMS Management of Anemia

• Assessment: Conduct a thorough history and physical examination. Look for signs of pallor, jaundice, tachycardia, hypotension, and other symptoms indicative of anemia.

• Oxygen Therapy: Administer oxygen as needed to improve tissue oxygenation. IV Access and Fluids: Establish IV access for potential fluid resuscitation, especially in cases of acute blood loss.

• Monitor Vitals: Continuously monitor vital signs to detect any signs of deterioration.

• Pain Management: Provide appropriate pain relief, particularly for patients with conditions like sickle cell disease.

• Transport: Ensure rapid and safe transport to the appropriate medical facility for further evaluation and treatment.

Understanding the types and causes of anemia can help EMS Providers deliver better care and make informed decisions in the prehospital setting, ultimately improving patient outcomes.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell 

EMS Medication Administration - Intravenous (IV) Catheter Complications

EMS Providers need to be aware of the potential complications associated with IV catheter placement, their presentations, and how to manage them.

Here’s an overview:

1. INFILTRATION

Definition: Leakage of IV fluid into the surrounding tissue.

Presentation:

• Swelling at the insertion site
• Coolness to the touch
• Pallor (pale skin)
• Discomfort or pain

Management:

• Discontinue the IV immediately.
• Elevate the affected limb.
• Apply a warm or cold compress based on patient comfort and solution infiltrated.

2. EXTRAVASATION

Definition: Leakage of vesicant (irritating) fluids into the surrounding tissue.

Presentation:

• Similar to infiltration, but with more severe symptoms
• Pain or burning at the site
• Blistering or tissue necrosis

Management:

• Stop the IV immediately.
• Elevate the limb and apply a cold compress.
• Notify medical control for further treatment recommendations, which may include specific antidotes.

3. OCCLUSION

Definition: Blockage of the IV catheter, preventing fluid flow.

Presentation:

• Difficulty or inability to infuse fluids
• Backflow of blood into the IV line

Management:

• Check for kinks or clamps on the tubing.
• Attempt to flush the catheter gently.
• If occlusion persists, discontinue and restart IV at a different site.

4. HEMATOMA

Definition: Collection of blood outside the vessel due to vein damage during insertion.

Presentation:

• Swelling and bruising at the insertion site
• Tenderness and discoloration

Management:

• Apply direct pressure to the site to stop bleeding.
• Apply a cold compress to reduce swelling.
• Avoid using the same site for subsequent IV attempts.

5. CATHETER SHEAR

Definition: A rare but serious complication where part of the catheter breaks off inside the vein.

Presentation:

• Sudden pain during insertion or movement of the catheter
• Potential for embolization of the catheter fragment

Management:

• Avoid using excessive force during insertion.
• If suspected, discontinue IV immediately and contact medical control for further instructions, which may include imaging to locate the fragment.

6. VASOVAGAL REACTIONS

Definition: Reflex reaction to pain or anxiety causing sudden drop in heart rate and blood pressure.

Presentation:

• Dizziness or lightheadedness
• Nausea
• Pale skin and sweating
• Fainting or near fainting

Management:

• Lay the patient flat and elevate the legs.
• Loosen any tight clothing.
• Provide reassurance and monitor vital signs.

7. PHLEBITIS

Definition: Inflammation of the vein.

Presentation:

• Redness and warmth along the vein
• Tenderness or pain at the site
• A palpable cord-like vein

Management:

• Discontinue the IV.
• Apply a warm compress.
• Use anti-inflammatory medications if appropriate.

8. INFECTION

Definition: Introduction of bacteria at the insertion site, potentially leading to local or systemic infection.

Presentation:

• Redness, warmth, and swelling at the site
• Purulent drainage
• Fever and chills (systemic infection)

Management:

• Discontinue the IV.
• Clean the site and cover with a sterile dressing.
• Notify medical control for possible antibiotic treatment.

PREVENTION TIPS

• Aseptic Technique: Always use aseptic technique during insertion.
• Proper Site Selection: Choose an appropriate site and avoid joints or areas with poor circulation.
• Securement: Secure the catheter well to prevent movement.
• Monitoring: Regularly check the IV site for signs of complications.

By recognizing and managing these complications promptly, EMS Providers can ensure patient safety and improve outcomes during IV therapy.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Hantke, J (2022) IV Placement and Management. Appropedia. Accessed May 22, 2024.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

EMS Medication Administration - Intravenous (IV) Catheter Placement

IV catheter placement is a critical skill for EMS Providers who are at the level of AEMT or above, in most states. Proper technique ensures effective treatment and minimizes complications.

Here are the recommended steps for IV catheter placement:

Preparation

Gather Supplies:

• IV catheter (appropriate gauge)
• Tourniquet
• Antiseptic wipes (e.g., alcohol, chlorhexidine)
• Sterile gauze
• Adhesive dressing or securement device
• IV extension set or saline lock
• Saline flush
• Tape

Gloves and other personal protective equipment (PPE)

Patient Assessment:

Identify a suitable vein: Look for a prominent, straight vein.

Consider patient-specific factors: Age, condition, hydration status, and vein quality.

Explain Procedure:

Inform the patient about the procedure to gain their cooperation and reduce anxiety.

Insertion

Prepare the Site:

Apply the tourniquet above the chosen site to engorge the vein.

Palpate the vein to confirm its location and direction.

Cleanse the site thoroughly with antiseptic wipes in a circular motion, starting from the center and moving outward. Allow the site to dry.

Insert the Catheter:

Don gloves.

Hold the catheter at a 10-30 degree angle to the skin, bevel up.

Insert the needle into the vein, looking for a flashback of blood in the catheter chamber.

Advance the needle slightly to ensure the catheter tip is in the vein.

Advance the Catheter:

Slide the catheter off the needle into the vein while holding the needle stationary.

Release the tourniquet once the catheter is fully advanced.

Securing and Flushing

Remove the Needle:

Retract the needle completely, and dispose of it in a sharps container.

Secure the Catheter:

Connect the IV extension set or saline lock.

Flush the catheter with saline to ensure patency.

Secure the catheter with an adhesive dressing or a securement device to prevent dislodgement.

Tape the IV tubing in place if connected to a fluid bag.

Monitoring and Documentation

Monitor the Site:

Check for signs of infiltration, phlebitis, or infection.

Monitor the patient's response to the IV.

Documentation:

Record the size of the catheter, insertion site, time, date, and any complications or observations.

Troubleshooting

If Initial Attempt Fails:

Reassess vein selection and technique.

Try another site or use a smaller gauge catheter.

Consider alternative access methods, such as intraosseous (IO), if IV access remains difficult and is urgently needed.

Post-Insertion Care

Patient Comfort:

Ensure the patient is comfortable and the IV site is not causing pain or discomfort.

Educate the patient on how to care for the IV site if it will remain in place for an extended period.

By following these steps, EMS Providers at the appropriate level can effectively and safely place IV catheters, ensuring optimal patient care and minimizing potential complications.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Hantke, J (2022) IV Placement and Management. Appropedia. Accessed May 22, 2024.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell