Emergency Medical Technician toEmergency Medical TechnicianKansas EMS Scope of Practice Transition Project                ...
Copyright © 2010, Kansas Board of EMSAll rights reserved. No part of the material protected by this copyright may be repro...
Module 1: Airway and BreathingModule 2: AssessmentModule 3: Pharmacological InterventionsModule 4: Emergency Trauma CareMo...
Module 1: Airway and Breathing                                 4
• Small volume nebulizer are devices that contain a small chamber for fluid based  medications to be placed. By flowing ox...
• During treatment have the patient  breath in deeply if tolerated.• Some patients may want to hold the  nebulizer. If so ...
* Some patientssuch as the Elderlyand Children maybenefit with the useof a facemask whenusing a nebulizer                 ...
•   BSI percautions•   Physical Exam / History•   Vitals•   Oxygen if needed•   Obtain need for Nebulized treatment•   Sta...
* If the tidal volume (normal inspiration/ventilation) is to low orrespiratory rate is to slow. You may need to use a nebu...
•   BSI precautions•   Provide oxygen•   Perform history / exam•   Vitals•   Standing orders, online medical control•   Ga...
11
Infant   Adult/Child1              12              212
The EMT must always be able to  Visualize                 the entire forceps.                                  13
1. BSI precautions2. Identify choking patient3. Follow BLS guidelines4. Conscious Adults and Children receive abdominal th...
Manually Triggered Ventilator                          15
Mouth-to-maskTwo person bag-valve-maskOne-person bag-valve-maskMouth to Mouth without a barrier device                    ...
Indications . . .Contraindications&Complicationsof the MTV                17
Manually Triggered Ventilator                                18
19
Depthand      Rate             20
Indications . . .Contraindications&Complicationsof the Automatic Transport Ventilator                                     ...
SEE SKILL SHEET   Automatic Transport Ventilator                                    22
Gastric  Decompression              23
Initial steps in the management ofGastric DistentionReposition Airway   Cricoid Pressure   Ventilate Slowly               ...
Reposition AirwayA poor airway promotes gastric distention                                            25
Cricoid PressureCloses off the esophagus and     routes air to lungs                               26
Ventilate Slowly               27
Manual  Decompre         ssion         of the stomach                    28
Gastric Tubes                29
EMT Use of Gastric TubesOG NG                           30
Indication:                             Contraindication:*Gastric destintion is present and      *Caution in esophageal di...
Indication:                                    Contraindication:*Threat of aspiration.                         *Caution in...
Not all supraglottic airways allow for the insertion of gastric tubes. The airwaysthat do so include:*Combitube*King Airwa...
CO2 Monitoring/Caponography:*The amount of end tidal CO2 is an accurate indicator of the abilityof the patient to exchange...
Colorimetric devices use a chemically treated paper thatresponds to the level of CO2 in the air that interacts withthe pap...
Capnograph        36
Exhaled Air Flow             Legend          Litmus Paper                   37
Capnometer allows EMT’s to assess.           *Airway placement.           *Dislodgement of ET tube.           *Effectivene...
Waveform Components   A-B is the inspiration/dead space marker                      B-C is the exhalation upstroke        ...
*A-B is the inspiration/dead space exhalation marker.                  CO *B-C is the exhalation upstroke where gases from...
Poor Waveform   CO2                                     d                          c                  a   b               ...
Numeric ReadoutsWaveform Display                                 42
Airway Placement    Confirmation                                     using End-Tidal CO2The supraglottic airways placed by...
Ensuring adequate   Ventilations                                    using End-Tidal CO2The EMT can use the end tidal CO2 r...
Early indication of                using End-Tidal CO2                                  45
EtCO2                                                         24                                                         E...
47
End-Tidal CO2 Monitoring                           48
Pulse Oximetry                 49
Light    LED           DetectorHow Pulse Oximetry Works                             50
Equal to or greater thanWhat is normal?                            51
52
Pulse Oximeter                 53
Scene Size Up (No Pulse Oximetry)Initial Assessment (May include use of the pulse oximeter)    1.   Airway    2.   Breathi...
> 95 %        “Normal”91% - 94%     Mild hypoxia.86% - 90%     Moderate hypoxia.< 85%         Severe hypoxia.             ...
56
Assess and treat patient, not the oximeterNever withhold oxygen if S/S of hypoxia orhypoxemia are present – regardless of ...
58
Pulse Oximetry                 59
Module 2: Assessment                       60
61
62
One of the key concerns has been reliability of the non-invasive measurement ascompared to manual auscultation. Rule of th...
Module 3: Pharmacological Intervention                                         64
WhyMedications?See EMR transition media for the Five rights. Use EMT pages 66-73for the medication formulary.             ...
Rights         66
Right    Medication             67
Right    Patient              68
Right    Dose           69
Right    Route            70
Right    Time           71
INHALATIONEMT Medication Routes                   72
Forms of Medication                 73
EMT MedicationSc pe                 74
Albuterol Sulfate               75
Aspirin    76
77
78
GlucagonAuto-Injector  (Soon Available)                     © Enject                                79
80
81
Mark 1 or Duodote Kit                  82
Mark 1 Kit1   23   4           56   7           8              83
84
Setting the Stage for theAdministrationof Medication                            85
Medication Administration                            86
Module 4: Emergency Trauma Care                                  87
Pelvic Wrap   SplintAny pelvic fracture is at risk for significant blood loss and the emt must stabalize thefracture appro...
89
90
91
PASG:*When using this as a splinting device, the EMT should apply the device and inflate it onlyenough to provide stabiliz...
Module 5: Emergency Medical Care                                   93
94
RA     - -           I    +                        -                                  LA              II            III   ...
96
97
EKG Leads            98
BloodGlucometer        See EMR transition media for glucometer and diabetic emergencies.                                  ...
Glucose     Insulin                                        Insulin on receptor     Glucose enters cell                    ...
Infant                 40 – 90 mg/dLChild < 2 years        60 – 100 mg/dLChild > 2 years to Adult 70 – 105mg/dL           ...
Newborn        < 30 and > 300 mg/dLInfant         < 40 mg/dLAdult Female   < 40 and > 400 mg/dLAdult Male     < 30 and > 3...
Types of       Diabetes             103
Clinical      Presentation                104
Emergency Care of      Diabetes                    105
How a Glucometer Works                   106
107
108
Puncture Sites          109
110
111
112
113
114
115
Maintenance and Use                116
Trouble Shooting            117
OralGlucose       Administration                118
119
Blood Glucometer                   120
Catheters            121
Texas Catheter         122
Foley Catheter         123
Monitoring     124
Handling   125
Documentation         126
Complications        127
Urinary Catheter Monitoring                              128
Photography and Image Credits©DuodoteSlide 70© EnjectSlide 68© iStock Photography. Used with permission. No resale or repr...
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Emt transition lesson media 2012

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Emt transition lesson media 2012

  1. 1. Emergency Medical Technician toEmergency Medical TechnicianKansas EMS Scope of Practice Transition Project 1
  2. 2. Copyright © 2010, Kansas Board of EMSAll rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form without written permission from the copyrightowner or completion of a Kansas Board of EMS approved Train the Trainer program. Additional illustration and photo credits in the support materials of thisdocument constitute a continuation of this copyright page.The information in this lesson plan is based on the most current recommendations of responsible medical sources. The Kansas Board of EmergencyMedical Services, the Friesen Group, and all curricula reviewers, however, make no guarantee as to, and assume no responsibility for, the correctness,sufficiency, or completeness of any information or contents in this program. Local agencies and individuals teaching or participating in this course shouldensure their own safety and operate under the medical oversight of their local physician medical direction or the medical direction of the agency/programdelivering this education.This material is intended as a guide to facilitate the bridging of existing certified technicians to the new scope of practice in Kansas EMS. It is not intended asa statement of the standards or absolute practices of care required in any particular situation. Circumstances and the patients condition can and will varywidely from one situation to another. This course material does not represent or advise emergency medical personnel of any legal authority to perform theactivities or procedures discussed in this material. Legal authority and permission to practice emergency medical care must be determined at the local level.All patients and providers described in this material are fictitious. 2
  3. 3. Module 1: Airway and BreathingModule 2: AssessmentModule 3: Pharmacological InterventionsModule 4: Emergency Trauma CareModule 5: Emergency Medical Care 3
  4. 4. Module 1: Airway and Breathing 4
  5. 5. • Small volume nebulizer are devices that contain a small chamber for fluid based medications to be placed. By flowing oxygen or air through the chamber at a sufficient rate, the fluid medication is aerosolized into a vapor mist that can be administered to the patient as they breath.• Before beginning the administration of medication through a small volume nebulizer, ensure that appropriate (BSI) are in place and utilized.• While the equipment that you will be using is not expected to remain sterile, it is important that you keep it clean. Replace any contaminated items.• Reasons why small volume nebulizers may be used? Used in bronchial asthma and other reversable bronchospasm that is associatedwith chronic bronchitis and emphysema. Small Volume Nebulizer 5
  6. 6. • During treatment have the patient breath in deeply if tolerated.• Some patients may want to hold the nebulizer. If so let them.• Repeat dosages. Check local protocols. Nebulizer 6
  7. 7. * Some patientssuch as the Elderlyand Children maybenefit with the useof a facemask whenusing a nebulizer Nebulizer With Mask 7
  8. 8. • BSI percautions• Physical Exam / History• Vitals• Oxygen if needed• Obtain need for Nebulized treatment• Standing orders or online medical direction• 5 rights (Patient, Medication, Dose, Route, Time.• Assemble Kit• Add medication• Connect Oxygen• Flow rate 6 - 8 LPM for 5 – 10 minutes.• Repeat Exam / Vitals Small Volume Nebulizer 8
  9. 9. * If the tidal volume (normal inspiration/ventilation) is to low orrespiratory rate is to slow. You may need to use a nebulizer withBVM. Check local protocols. BVM with Nebulizer 9
  10. 10. • BSI precautions• Provide oxygen• Perform history / exam• Vitals• Standing orders, online medical control• Gather necessary equipment Oxygen, Nebulizer kit, BVM, Medication• Medication expiration• 5 rights• Assemble kit to BVM add medication• Connect O2 to BVM 15 LPM.• Connect O2 to Nebulizer 6-8 LPM.• Ventilate 8-10 times a minute BVM with Small Volume Nebulizer 10
  11. 11. 11
  12. 12. Infant Adult/Child1 12 212
  13. 13. The EMT must always be able to Visualize the entire forceps. 13
  14. 14. 1. BSI precautions2. Identify choking patient3. Follow BLS guidelines4. Conscious Adults and Children receive abdominal thrusts5. Unconscious Adults and Children receive chest thrusts6. Infants receive back blows and chest thrusts7. Grasp magills8. Open mouth9. Insert magills10. Suction11. Reassess patient12. Provide Interventions Magill’s Forceps 14
  15. 15. Manually Triggered Ventilator 15
  16. 16. Mouth-to-maskTwo person bag-valve-maskOne-person bag-valve-maskMouth to Mouth without a barrier device 16
  17. 17. Indications . . .Contraindications&Complicationsof the MTV 17
  18. 18. Manually Triggered Ventilator 18
  19. 19. 19
  20. 20. Depthand Rate 20
  21. 21. Indications . . .Contraindications&Complicationsof the Automatic Transport Ventilator 21
  22. 22. SEE SKILL SHEET Automatic Transport Ventilator 22
  23. 23. Gastric Decompression 23
  24. 24. Initial steps in the management ofGastric DistentionReposition Airway Cricoid Pressure Ventilate Slowly 24
  25. 25. Reposition AirwayA poor airway promotes gastric distention 25
  26. 26. Cricoid PressureCloses off the esophagus and routes air to lungs 26
  27. 27. Ventilate Slowly 27
  28. 28. Manual Decompre ssion of the stomach 28
  29. 29. Gastric Tubes 29
  30. 30. EMT Use of Gastric TubesOG NG 30
  31. 31. Indication: Contraindication:*Gastric destintion is present and *Caution in esophageal disease orinterfering with ventilations. esophageal traum.*When patients will be ventilated *Facial trauma.for long period of time. *Esophageal obstruction. NG TUBES Paramedic use only! Advantages: Disadvantages: *Tolerated by alert patients. *Uncomfortable for patients. *Doesn’t interfere with intubation. *May cause patient to vomit. *Mitigates recurrent gastric *Interfere with BVM,MTV,ATV. distention. *Patient can still talk.Complications: Nasal gastric trauma from poor technique. ET placement. 31
  32. 32. Indication: Contraindication:*Threat of aspiration. *Caution in esophageal disease or*Need to decrease pressure of the esophageal trauma.stomach on the diaphram. *Esophageal obstruction.*Patient is unconscious. OG TUBES EMT is allowed to use this device.Advantages: Disadvantages:*May use larger tubes. *Uncomfortable for conscious patients.*Safer to insert in patients with facial *May cause retching and vomiting withFractures. patients that have intact gag reflex.*Lower risk of nasal bleeding. Complications: Patient may bite the tube. 32
  33. 33. Not all supraglottic airways allow for the insertion of gastric tubes. The airwaysthat do so include:*Combitube*King Airway*Esophageal Gastric Tube Airway*Laryngeal Mask AirwayOnce the EMT has taken care of the ABC’s, they will develop and idea of whetherthere is a threat from gastric distention. Threats that indicate the need for gastricdecompression.*Inability to adequatley ventilate due to increased lung resistance.*Vomiting. Orogastric Tubes 33
  34. 34. CO2 Monitoring/Caponography:*The amount of end tidal CO2 is an accurate indicator of the abilityof the patient to exchange O2 for CO2 at the alveoli/capillary level.EMT’s can use this tool as a mechanism to assess the placement ofairway devices as well as to guide them in the provisions of effectiveCPR. End-Tidal CO2 Monitoring 34
  35. 35. Colorimetric devices use a chemically treated paper thatresponds to the level of CO2 in the air that interacts withthe paper in the colorimetric device. The higher the CO2level, the more color change. Colorimetric Device 35
  36. 36. Capnograph 36
  37. 37. Exhaled Air Flow Legend Litmus Paper 37
  38. 38. Capnometer allows EMT’s to assess. *Airway placement. *Dislodgement of ET tube. *Effectiveness of CPR. *Spontaneous circulation (ROSC). *Efficacy of breathing treatments.Detector Read-out 38
  39. 39. Waveform Components A-B is the inspiration/dead space marker B-C is the exhalation upstroke C-D is the continuation of exhalation D is the end tidal value (peak) D-E is the inspiration washout 39
  40. 40. *A-B is the inspiration/dead space exhalation marker. CO *B-C is the exhalation upstroke where gases from lungs are detected. 2 *C-D is the continuation of exhalation. *D is the end tidal value where peak CO2 is foundNormal Waveform *Efficacy of breathing treatments. d c a b e Time 40
  41. 41. Poor Waveform CO2 d c a b e Time 41
  42. 42. Numeric ReadoutsWaveform Display 42
  43. 43. Airway Placement Confirmation using End-Tidal CO2The supraglottic airways placed by EMT’s are generally built such that they may be used ineither the trachea or esophogus. The EMT must know in which location the tube is placedand ventilate appropriatley with the device. Using some form of end tidal CO2 monitoringallows the EMT to guage the effectiveness of the airway based off the amount of CO2return. 43
  44. 44. Ensuring adequate Ventilations using End-Tidal CO2The EMT can use the end tidal CO2 readings as a mechanism to avoid hyperventilation orhypoventilation of the patient. 44
  45. 45. Early indication of using End-Tidal CO2 45
  46. 46. EtCO2 24 EtCO2 Early indication of 20 INEFFECTIVEEffectiveness of CPR:1. End tidal CO2 measure to assist in ventilation. Compressions EtCO2a. Target value normal range 35-45 ETCO2.b. Hyperventilation the number will fall. 16c. Hypoventilation the number will rise.2. End tidal CO2 measure to assist in compressions EtCO2a. Correlation with ETCO2 dropping ineffective CPR.b. Switching rescuers should result in increase 12 ETCO2. 46
  47. 47. 47
  48. 48. End-Tidal CO2 Monitoring 48
  49. 49. Pulse Oximetry 49
  50. 50. Light LED DetectorHow Pulse Oximetry Works 50
  51. 51. Equal to or greater thanWhat is normal? 51
  52. 52. 52
  53. 53. Pulse Oximeter 53
  54. 54. Scene Size Up (No Pulse Oximetry)Initial Assessment (May include use of the pulse oximeter) 1. Airway 2. Breathing (Observe, Estimate, Listen, Oximeter) 3. Circulation 4. Disability (LOC) 5. Expose and ExamineHistory and Physical Assessment (Pulse oximeter)Detailed Assessment (Pulse oximetry)On-Going Assessment (Pulse oximetry)Assessing Results 54
  55. 55. > 95 % “Normal”91% - 94% Mild hypoxia.86% - 90% Moderate hypoxia.< 85% Severe hypoxia. (Bledsoe, Porter & Cherry, 2007, 463)Assessing Results 55
  56. 56. 56
  57. 57. Assess and treat patient, not the oximeterNever withhold oxygen if S/S of hypoxia orhypoxemia are present – regardless of thereading on the oximeterPulse oximeters measure saturation of thehemoglobin, not oxygenation or ventilation.Oximetry – 3 Basic Rules 57
  58. 58. 58
  59. 59. Pulse Oximetry 59
  60. 60. Module 2: Assessment 60
  61. 61. 61
  62. 62. 62
  63. 63. One of the key concerns has been reliability of the non-invasive measurement ascompared to manual auscultation. Rule of thumb. When you find a NIBP reading out ofnormal range for the context of your patient, double check it with a manual BP.Appropriate cuff should cover 2/3 of the upper arm. HAVE THE STUDENTS USE THE FORMULARY OVER THE MEDICATIONS TO STUDY AND FILL IN THE WORK BOOK AFTER THIS CLASS IS OVER. HAVE THEM TAKE IT HOME. SO NEXT CLASS CAN TAKE TEST, ASK QUESTIONS, FOCUSE MORE ON THE SKILL. Non-Invasive Blood Pressure Monitoring 63
  64. 64. Module 3: Pharmacological Intervention 64
  65. 65. WhyMedications?See EMR transition media for the Five rights. Use EMT pages 66-73for the medication formulary. 65
  66. 66. Rights 66
  67. 67. Right Medication 67
  68. 68. Right Patient 68
  69. 69. Right Dose 69
  70. 70. Right Route 70
  71. 71. Right Time 71
  72. 72. INHALATIONEMT Medication Routes 72
  73. 73. Forms of Medication 73
  74. 74. EMT MedicationSc pe 74
  75. 75. Albuterol Sulfate 75
  76. 76. Aspirin 76
  77. 77. 77
  78. 78. 78
  79. 79. GlucagonAuto-Injector (Soon Available) © Enject 79
  80. 80. 80
  81. 81. 81
  82. 82. Mark 1 or Duodote Kit 82
  83. 83. Mark 1 Kit1 23 4 56 7 8 83
  84. 84. 84
  85. 85. Setting the Stage for theAdministrationof Medication 85
  86. 86. Medication Administration 86
  87. 87. Module 4: Emergency Trauma Care 87
  88. 88. Pelvic Wrap SplintAny pelvic fracture is at risk for significant blood loss and the emt must stabalize thefracture appropriatley.Pelvic fractures can be splinted in a number of ways.*PASG*Sheet wrap*Inverted KED*Commercial pelvic splint 88
  89. 89. 89
  90. 90. 90
  91. 91. 91
  92. 92. PASG:*When using this as a splinting device, the EMT should apply the device and inflate it onlyenough to provide stabilization. When using the device, it is best placed on a long spineboard before the patient is log rolled. The device is fastened around the patient andinflated to allow for immobilization.Sheet Wrap:*When using a sheet wrap the procedure is straight forward.1. Take a cloth and fold it into a 8” wide, flat band.2. Center it under the buttocks so that when wrapped it will cover the greater trochanters.3. Wrap the sheet across the symphysis pupis and tie with a half knot.4. Tighten it to stabilize the pelvis.5. Secure with safety pins.6. Move patient to LSB.KED:Invert the KED use the body portion to secure the pelvic region. Move to LSB. Pelvic Splinting 92
  93. 93. Module 5: Emergency Medical Care 93
  94. 94. 94
  95. 95. RA - - I + - LA II III + + LL Ground 95
  96. 96. 96
  97. 97. 97
  98. 98. EKG Leads 98
  99. 99. BloodGlucometer See EMR transition media for glucometer and diabetic emergencies. 99
  100. 100. Glucose Insulin Insulin on receptor Glucose enters cell opens glucose channel InsulinGlucose receptorchannelBody Cell Nucleus The Body’s Glucose Needs 100
  101. 101. Infant 40 – 90 mg/dLChild < 2 years 60 – 100 mg/dLChild > 2 years to Adult 70 – 105mg/dL (Pagana & Pagana, 1997, 427) Normal Blood-Glucose Levels 101
  102. 102. Newborn < 30 and > 300 mg/dLInfant < 40 mg/dLAdult Female < 40 and > 400 mg/dLAdult Male < 30 and > 300 mg/dL (Pagana & Pagana, 1997, 427) Critical Values 102
  103. 103. Types of Diabetes 103
  104. 104. Clinical Presentation 104
  105. 105. Emergency Care of Diabetes 105
  106. 106. How a Glucometer Works 106
  107. 107. 107
  108. 108. 108
  109. 109. Puncture Sites 109
  110. 110. 110
  111. 111. 111
  112. 112. 112
  113. 113. 113
  114. 114. 114
  115. 115. 115
  116. 116. Maintenance and Use 116
  117. 117. Trouble Shooting 117
  118. 118. OralGlucose Administration 118
  119. 119. 119
  120. 120. Blood Glucometer 120
  121. 121. Catheters 121
  122. 122. Texas Catheter 122
  123. 123. Foley Catheter 123
  124. 124. Monitoring 124
  125. 125. Handling 125
  126. 126. Documentation 126
  127. 127. Complications 127
  128. 128. Urinary Catheter Monitoring 128
  129. 129. Photography and Image Credits©DuodoteSlide 70© EnjectSlide 68© iStock Photography. Used with permission. No resale or reproduction of these images is permitted.Slides: 29, 83,© Jeremy Hoose and Destry Lynn (Labette Health EMS) Used with permission. No resale or reproduction of these images ispermitted.Slides 19, 109,110, 111, 112, 113, 114, 115© Jon E. Friesen, Used with permission. No resale or reproduction of these images is allowed without express permission of thephotographer.Slides:6,7,9, 11, 12, 15, 35, 36, 37, 38, 40, 41, 42, 45, 47, 50, 51, 61, 62, 64, 65, 66, 67, 69, 70, 71, 72, 77, 78, 79, 82, 84, 85, 88, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 107,© Lippincott Williams & Wilkins. Used with permission. No resale or reproduction of these images is permitted.Slide 83, 129

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