Medic Assist

1. Medic Assist

2. Medic Assist Often when we are called to respond to treat a patient, we arrive to find a patient that has a life threatening injury or illness. Once Medic arrives we may be asked to assist them in the ongoing treatment of that patient.

3. Medic Assist • Many of our protocols indicate procedures we are expected to help Medic carryout. • In this lesson we will address • some of these procedures • and their protocol. Please make sure your station has the latest copy of the local protocols.

4. Medic Assist • Our protocols and contract indicate additional performance measures and skills that are outlined by local medical control. These duties are to assist Medic personnel and to expedite patient care activities. • As a EMT you should • know your local • protocols.

5. Medic Assist • NEW: CHANGE IN PROTOCOL • 3.2.9 Cardiac Arrest Pediatric • 1. Although rare in children, pediatric ventricular fibrillation arrest it is mostly seen in cardiomyopathies, myocarditis, hypoxia, or intoxication. In this age group, early defibrillation is important. • 2. After each defibrillatory shock, cardiopulmonary resuscitation should commence immediately.

6. NEW: CHANGE IN PROTOCOL • 3. Chest compressions should be hard and fast, bringing the thumbs or hand on the upstroke off the chest for maximum recoil. The duration between compressions should be enough time to allow for ventricular filling. • 4. Since hypoxemia is a major cause of cardiac arrest in the pediatric population, airway control and oxygenation is of paramount importance. The maximum breaths per minute is 20. Because of the tendency for all providers to over ventilate, feedback in the form of end-tidal CO2 of verbal ques is important to the provider administering the ventilations. Cont.

7. NEW: CHANGE IN PROTOCOL • 5. Pediatric patients in cardiac arrest from a medical etiology should never be expeditiously carried to the ambulance when it arrives. For maximum survival benefit, resuscitative efforts should be conducted on the scene with two rescuers performing CPR. • 6. Resuscitation and transport should be performed on all pediatric cardiac arrest patients regardless of etiology (medical or trauma). Unlike adult patients, all appropriate ALS medications should be administered for both medical and trauma patients. Cont.

8. Medic Assist • We will also look at some new equipment that Medic will be using and how we can assist them. Please make sure to view the video that is attached to this section of training under “Course Documents”

9. Medic Assist What do we assist Medic with? • 1. Apply pulse oximeter and cardiac monitor. • 2. Prepare IV set-up if advised. With any patient suffering from chest pain. Be ready to assist medic with the setup of 12 lead.

10. Medic Assist What do we assist Medic with? • Anaphylactic Reaction • 1. If a severe anaphylactic reaction is present (wheezing, respiratory distress, feeling of throat closing • up, and hypotension), may assist patient in administration of personal anaphylaxis kit • (Epi-Pen, Ana-Kit). • 2. Apply pulse oximeter and cardiac monitor. • 3. Prepare IV set-up and any medication if advised.

11. Medic Assist What do we assist Medic with? • Respiratory Distress • 1. If a severe asthma attack is present (wheezing, respiratory distress), may assist patient in • administration of personal metered dose inhaler or nebulizer. • 2. Apply pulse oximeter and cardiac monitor. • 3. Prepare nebulizer set-up if advised. • 4. Prepare IV set-up and any medication if advised. • 5. If continuous positive airway pressure (CPAP) is to be attempted, prepare appropriate equipment. • 6. If intubation is to be performed assist in • tie down and check for tube location • with stethoscope.

12. Medic Assist What do we assist Medic with? • Medic Assist Burns • 1. For burns > 25% body surface area or any inhalation, apply cardiac monitor and pulse oximetry. • 2. Prepare IV set-up and any medication if advised. • 3. If intubation is to be attempted, prepare appropriate equipment and assist in preparing end-tidal CO2 from monitoring • device.

13. Medic Assist What do we assist Medic with? • Chest Pain • 1. If pain considered to be cardiac in origin per the patient, may assist patient in administration of • personal dose of nitroglycerine. • 2. Apply pulse oximeter and cardiac monitor. • 3. Prepare IV set-up and any medication if advised.

14. Medic Assist What do we assist Medic with? • Choking • 1. Apply pulse oximeter and cardiac monitor. • 2. Prepare IV set-up and any medication if advised. • 3. If intubation is to be attempted, prepare appropriate equipment and assist in preparing end-tidal CO2 monitoring device.

15. Medic Assist What do we assist Medic with? • Near Drowning • 1. Apply pulse oximeter and cardiac monitor. • 2. Prepare IV set-up and any medication if advised. • 3. If continuous positive airway pressure (CPAP) is to be attempted, prepare appropriate equipment. • 4. If intubation is to be attempted, prepare appropriate equipment and assist in preparing end-tidal CO2 monitoring device.

16. Medic Assist • 4.9 INTRAVENOUS ACCESS ASSIST1 • Equipment • 1. 500 mL normal saline intravenous fluid bag • 2. Drip chamber • 3. Extension tubing • 4. Angiocath • 5. Constricting band • 6. Alcohol • 7. Tape

17. Medic Assist • 4.9 INTRAVENOUS ACCESS ASSIST • Description • 1. Assisting Medic personnel in assembling intravenous fluid set and supplies required for performing intravascular access. • Indications • 1. Any patient where intravascular access is to be performed for fluid or medication administration. • Contraindications • 1. None.

18. Medic Assist • 4.9 INTRAVENOUS ACCESS ASSIST1 • Procedure • 1. All necessary supplies as described above should be readily available before attempting intravascular access. • 2. Connect drip chamber tubing to extension tubing. • 3. Remove tab from drip chamber insertion site on IV fluid bag.

19. Medic Assist • 4.9 INTRAVENOUS ACCESS ASSIST1 • 4. Insert, or spike, drip chamber into IV bag. Squeeze chamber and release so as to partially (50%) fill the chamber with saline from the IV bag. • 5. Open all clamps and remove the end cap on the IV tubing and flush IV fluid completely through the tubing. Replace the end cap when all air columns and bubbles have cleared the tubing.

20. Medic Assist • 4.9 INTRAVENOUS ACCESS ASSIST1 • 6. Assist in handling the angiocath and constricting band. • 7. Cut tape into 4 or 5 lengths of 2-3 inches each. • 8. If patient is an infant or child, prepare an arm board and bandages to make an arm board. • Complications • 1. Air embolus. #1 • 2. Infection.

21. Medic Assist • 4.9 INTRAVENOUS ACCESS ASSIST1 • Clinical Supplement • 1. It is always important to use extreme sterile technique when connecting the tubing to the IV bag. • 2. Always ensure that there is no air remaining in the IV tubing prior to fluid infusion.

22. Medic Assist • Pulse Oximetry Measurement • Indications • 1. Breathing problems or other symptom suggesting a respiratory etiology. • 2. Any patient complaining of breathing problems or chest discomfort, or any patient with a history of • respiratory distress or breathing problems that prompted the 9-1-1 call and is refusing treatment or transport. • Contraindications • 1. None.

23. Medic Assist • Pulse Oximetry Measurement • Procedure • 1. Prepare and assemble all equipment: • a. Cardiac monitor with oximeter device and cable with attached detection device (finger probe) • 2. Select finger and apply detection device by standard technique. • 3. Ensure pulse correlation. • 4. Obtain reading. • 5. Apply supplemental oxygen as required per protocol. • Side Effects • 1. None

24. Medic Assist • 12-Lead Electrocardiogram Electrode Placement • Indications • 1. Chest pain or other symptom suggesting a cardiac etiology. • 2. Any patient complaining of chest pain or chest discomfort, or any patient with a history of chest pain • or discomfort that prompted the 9-1-1 call and is refusing treatment or transport. • Contraindications • 1. None.

25. Medic Assist • 12-Lead Electrocardiogram Electrode Placement • Procedure • 1. Prepare and assemble all equipment: • a. 12-lead cable • b. Electrodes (10) • 2. Expose and prepare chest for electrode placement. This may require some limited shaving.

26. Medic Assist • 12-Lead Electrocardiogram Electrode Placement • 3. Apply electrodes as indicated: • a. Limb Leads • i. RA: Right upper extremity • ii. LA: Left upper extremity • iii. RL: Right lower extremity • iv. LL: Left lower extremity

27. Medic Assist • 12-Lead Electrocardiogram Electrode Placement • Indications • b Chest Leads • i. V1: 4th intercostal space to right of sternum • ii. V2: 4th intercostal space to left of sternum • iii. V3: Between V2 and V4 • iv. V4: 5th intercostal space at midclavicular line • v. V5: 5th intercostal space at anterior axillary line • vi. V6: 5th intercostal space at midaxillary line

28. Medic Assist

29. Medic Assist • 12-Lead Electrocardiogram Electrode Placement • 4. Instruct patient to be as motionless as possible and to refrain from talking. • 5. The 12-lead electrocardiogram will be obtained by the paramedic by standard technique. • Complications • None

30. Medic Assist • Medics New monitor will! • Assist you when bagging • a patient. • Assist you in speed of depth and • speed of compressions. • Monitors pulse oximetry and • Co2 • Interface our AED’s Please make sure to view the video that is attached to this section of training under “Course Documents”

31. Medic Assist