Seattle/King County EMT-B Class

1. Seattle/King County EMT-B Class

2. Introduction • EMS Online • http://www.emsonline.net/emtb • Class schedule • Message board • Lecture presentations

3. 1 2 3 4 Topics Airway Management: Chapter 7 Patient Assessment: Chapter 8 Communication and Documentation:Chapter 9 Adult SICK/NOT SICK

4. 1 Airway Assessment and Management

5. 1 Anatomy Review

6. 1 Breathing Process • Active part of breathing. • Diaphragm and intercostal muscles contract allowing the lungs to expand. • Pressure in the lungs decreases as they fill with air. • Air travels to the lungs. Inhalation

7. 1 Breathing Process, cont'd • Does not normally require effort. • Diaphragm and intercostal muscles relax. • The chest decreases in size, ribs and muscles assume their normal positions. • The increase in pressure forces air out. Inhalation Exhalation

8. 1 Gas Exchange • Inhalation delivers oxygen-rich air to alveoli. • Oxygen diffuses into the blood. • Breathing is primarily adjusted by the level of carbon dioxide in the blood.

9. 1 Adequate Breathing • Normal rate and depth • Regular rhythm • Good breath sounds in both lungs • Regular rise and fall movements in the chest • Easy, not labored

10. 1 Normal Breathing Rates • Adults 12 to 20 breaths/min • Children 15 to 30 breaths/min • Infants 25 to 50 breaths/min

11. 1 Inadequate Breathing • Irregular rhythm • Labored breathing • Muscle retractions • Pale or blue skin • Cool, clammy skin • Faster respiratory rate

12. 1 The Body’s Need for Oxygen

13. 1 What is Hypoxia? • Not enough oxygen for metabolic needs. • Develops when patient is either: • Breathing inadequately • Not breathing at all • Oxygen-starved environment

14. 1 Signs of Hypoxia • Nervousness, irritability, and fear • Tachycardia • Mental status changes • Use of accessory muscles for breathing • Difficulty breathing, possible chest pain

15. 1 Airway Assessment LOOK—LISTEN—FEEL

16. 1 Head Tilt—Chin Lift • Kneel beside patient’s head. • Place one hand on forehead. • Apply backward pressure. • Place tips of finger under lower jaw. • Lift chin.

17. 1 Jaw Thrust Maneuver • Kneel above patient’s head. • Place fingers behind angle of jaw. • Use thumbs to keep mouth open.

18. 1 Methods of Ventilation • Kneel above patient’s head. • Place fingers behind angle of jaw. Mouth-to-Mask

19. 1 Methods of Ventilation Mouth-to-Mask 1-person BVM

20. 1 Methods of Ventilation Non-rebreathing mask (NRM): Mouth-to-Mask • Provides up to 90% oxygen • Used at 10 to 15 L/min 1-person BVM Supplemental O2

21. 1 Methods of Ventilation Nasal Cannula: Mouth-to-Mask • Provides 24% to 44% oxygen • Used at 1 to 6 L/min 1-person BVM Supplemental O2

22. 1 Methods of Ventilation • One person maintains seal while the other delivers ventilations. Mouth-to-Mask 2-person BVM Supplemental O2 2-person BVM

23. 1 Supplemental Oxygen All patients in cardiac arrest should get oxygen. Any patient with a respiratory or cardiac emergency needs oxygen. Never withhold oxygen from anyone who may benefit from it.

24. 1 Artificial Ventilations • Adults 1 breath every 5 seconds • Children 1 breath every 3 seconds • Infants 1 breath every 3 seconds

25. 1 Adequate Ventilation Equal chest rise and fall Ventilating at appropriate rate Heart rate returns to normal

26. 1 Inadequate Ventilation Minimal or no chest rise and fall Ventilations too fast or slow Heart rate does not return to normal

27. 1 Sellick Maneuver • Place pressure on cricoid with thumb and index finger. • May be used (observed) during intubation by paramedics • Use on unconscious patients to prevent gastric distention.

28. 1 Gastric Distention • Artificial ventilation fills stomach with air. • Occurs if ventilations are too forceful or too frequent or when airway is blocked. • May cause patient to vomit. …and what if they vomit?

29. 1 Suctioning Equipment

30. 1 Proper Suctioning • Check the unit and turn it on.

31. 1 Proper Suctioning • Check the unit and turn it on. Select and measure proper catheter to be used.

32. 1 Proper Suctioning • Check the unit and turn it on. Select and measure proper catheter to be used. Open the patient’s mouth and insert tip.

33. 1 Proper Suctioning • Check the unit and turn it on. Select and measure proper catheter to be used. Open the patient’s mouth and insert tip. Suction as you withdraw the catheter.

34. 1 Proper Suctioning • Check the unit and turn it on. Select and measure proper catheter to be used. Open the patient’s mouth and insert tip. Suction as you withdraw the catheter. Never suction adults for more than 15 seconds.

35. 1 Stomas and Tracheostomy Tubes • Ventilations are delivered through the stoma. • Attach BVM device to tube or use infant mask. • Stoma may need to be suctioned.

36. 1 Oropharyngeal Airway Adjunct • Keeps the tongue from blocking the upper airway. • Allows for easier suctioning of the airway. • Used in conjunction with BVM device. • Used on unconscious patients without a gag reflex.

37. 1 Oropharyngeal Airway Adjunct 1. Select the proper size airway. 1

38. 1 Oropharyngeal Airway Adjunct 2. Hold the airway upside down and insert it in the patient’s mouth. 2

39. 1 Oropharyngeal Airway Adjunct 3 3. Rotate the airway 180° until the flange rests on the patient’s lips.

40. 2 Patient Assessment

41. 2 Patient Assessment • Scene size-up • Initial assessment • Focused history and physical exam • Detailed physical exam • Ongoing assessment Patient assessment is a process, not a procedure.

42. 2 Scene Size—Up • Dispatch information • Body Substance Isolation (BSI) • Inner circle/outer circle • Scene hazards • Safety concerns • Number of patients • Additional resources needed

43. 2 Scene Size—Up, continued • Body Substance Isolation (BSI) • Assumes ALL body fluids present a possible risk for infection • Latex or vinyl gloves must always be worn • Eye protection if patient is coughing • Mask (for yourself and the patient) • Gown

44. 2 Scene Size—Up, continued • Potential Hazards • Oncoming traffic • Unstable surfaces • Leaking gasoline • Downed electrical lines • Potential for violence • Hazardous materials

45. 2 Scene Size—Up, continued • Number of Patients • Determine the number of patients and their condition. • Assess what additional resources will be needed. • Triage to identify severity of each patient’s condition.

46. 2 Scene Size—Up, continued • Additional Resources • Medical resources • Additional units • Advanced life support • Non-medical resources • Law enforcement • Rescue / Special Teams

47. 2 Scene Size—Up, continued • Mechanism of Injury (MOI) • Helps determine the possible extent of injuries on trauma patients. • Guides preparation for care to patient. • Suggests equipment that will be needed. • Provides clues for further assessment.

48. 2 Scene Size—Up, continued • Mechanism of Injury (MOI) • Helps determine the possible extent of injuries on trauma patients. • Suggests equipment that will be needed. • Provides clues for further assessment.

49. 2 Scene Size—Up, continued • Nature of Illness (NOI) • Search for clues to determine the nature of illness. • Often described by the patient’s chief complaint. • Gather information from the patient and people on scene.

50. 2 Initial Assessment • Develop a general impression based on mechanism of injury (MOI) and/or nature of illness (NOI). • Assess airway, breathing, circulation. • Assess mental status. • Assess skin signs. Based on these signs alone, make a decision within 60 seconds.