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Focused History for Responsive Medical Patient. History of the present illnessSAMPLE historyFocused physical examBaseline vital signs. History of Present Illness. O
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1. Respiratory Emergencies Trinity EMS
2. Focused History for Responsive Medical Patient History of the present illness
SAMPLE history
Focused physical exam
Baseline vital signs
3. History of Present Illness O – Onset (what were you doing when it started?)
P – Provokes (does anything make it better or worse?)
Q – Quality (can you describe what it feels like?)
R – Radiation (does the pain travel to other body parts?)
S – Severity (0-10 scale with 10 being the worst)
T – Time (When did this start)
4. SAMPLE History S – Signs and symptoms
A – Allergies
M – Medications
P – Previous medical history
L – Last oral intake
E – Events leading to the illness
5. Focused Physical Exam Quick assessment of the following areas:
Head
Neck
Chest
Abdomen
Pelvis (not necessary if CC is respiratory)
Extremities
Posterior
6. Vital Signs Respirations (rate, quality, depth)
Pulse
Skin color, temperature, condition (capillary refill in infants and children)
Pupils
Blood pressure
O2 saturation (pulse oximeter)
Never rely on pulse oximeter as your only verification of a respiratory problem. Poor pulses, cold extremities and other factors can skew the reading.
7. Interventions and Transport Perform interventions as needed and transport the patient.
Consider ALS intercept if patient condition warrants it.
8. Focused History for Unresponsive Medical Patient Perform rapid physical exam
Obtain baseline vital signs
Consider request for advanced life support
Take a history of the present illness and a SAMPLE history from family or bystanders
9. Adequate Breathing Rates Adult 12-20 breaths per minute
Child 15-30 breathes per minute
Infant 25-50 breaths per minute
Be sure to check the depth of breathing also. Rate alone is not an indicator of sufficient respirations.
11. Assessing Lung Sounds Wheezes – high-pitched sounds which indicate narrowing of lower airways. Common in asthmatics and COPD patients.
Crackles – fine bubbling sounds causes by fluid in the alveoli usually heard on inspiration.
Rhonchi – lower pitched sounds that resemble rattling caused my mucous in the larger airways. (should be able to clear with a cough)
Stridor – high pitched sound heard on inspiration that indicates a partial obstruction of the trachea or larynx.
14. Medication Administration Assure the four “rights” for administration of a medication:
Right patient
Right medication
Right dose
Right route
15. Prescribed Inhalers Generic: albuterol, isoetharine, metaproterenol
Trade Name: Proventil, Ventolin, Bronkosol, Bronkometer, Alupent, Metaprel
16. Prescribed Inhalers Indications:
Patient exhibits signs and symptoms of respiratory emergency.
Patient has physician prescribed hand-held inhaler.
Medical direction gives specific authorization to use.
17. Prescribed Inhalers Contraindications:
Patient is unable to use device (not alert).
Inhaler is not prescribed for patient.
No permission has been given by medical direction.
Patient has already taken maximum prescribed dose prior to EMT-B’s arrival.
18. Prescribed Inhalers Dosage:
Number of inhalations is based on medical direction or physician’s order.
Actions:
Beta agonist bronchodilator dilates bronchioles, reducing airway resistance.
Side Effects:
Increased pulse rate
Tremors
Nervousness
19. Prescribed Inhalers Reassessment Strategies:
Gather vital signs
Perform focused reassessment of chest and respiratory function
Observe for deterioration of patient, if breathing becomes inadequate, provide artificial respirations
20. Respiratory Distress (SMO) FR
Routine Medical Care
Position of comfort
21. Respiratory Distress (SMO) BLS
FR care
Oxygen 2-6 LPM via nasal cannula (if on home O2, increase by 1 LPM).
History of bronchodilator therapy within past four hours.
Prescribed inhaler – assist patient with medication
22. Respiratory Distress (SMO) Contact Medical Control for nebulizer therapy.
Medications utilized
The first held nebulizer treatment > 12 years old
Proventil 0.083% solution, 3 ml, unit dose
Atrovent 0.02% solution, 0.5 mg/2.5 ml, unit dose
Empty both medications into nebulizer reservoir
The second and subsequent nebulizer treatments for adults and children > 12 years will be:
Proventil 0.083% solution, 3 ml, unit dose
Empty the full unit dose Proventil Solution into nebulizer reservoir
For Children < 12 years of age all nebulizer treatments will be:
Proventil 0.083% solution, 3 ml unit dose
Empty unit dose Proventil Solution (0.083% / 3ml) into nebulizer reservoir
23. Respiratory Distress (SMO) Instruct patient to breathe calmly and deeply
Vitals – monitor
Treatment Connect to oxygen and flow at 6 LPM
Lasts 5-15 minutes
Epipen Auto-injector 0.3 mg IM
Transport ASAP
24. Contraindications to nebulizer therapy > 6 treatments within the past 2 hours
Allergy to Albuterol (Ventolin, Proventil), or Atrovent (Ipratroprium Bromide)
HR >170 minute
BP > 160/100
Contraindication to Atrovent = allergy to soy lecithin or related food products such as soybean or peanuts.
25. Acute Pulmonary Edema FR
Routine Medical Care
BLS
Routine Medical Care
Sit patient up (High Fowlers), feet dangling
Loosen clothing
Oxygen 10-15 LPM nonrebreather mask if tolerated (if not tolerated, 4-6 LPM per nasal cannula).
If breathless/see cardiac arrest protocol
NTG – if systolic BP >100, may repeat every 5 minutes to a maximum of 3 doses.
Consider ALS assist, Transport ASAP
26. Anaphylactic Shock
27. Anaphylactic Shock FR
Routine Medical Care
BLS
Routine Medical Care
O2 10-15 LPM by NRB mask (if NRB mask not tolerated, give O2 at 4-6 LPM)
Epipen 0.3 mg IM (1:1000)
Transport ASAP
Epipen 0.3 mg IM may repeat in 5 minutes
28. Signs / Symptoms of Anaphylaxis Cardiovascular: hypoperfusion
Respiratory: Acute respiratory distress, stridor, wheezing
CNS: Headache, dizziness, and seizure
GI: Abdominal pain, nausea, vomiting, and diarrhea
Skin: Hives, flushing, itching