1 / 139

Chapter 40

Chapter 40. ALS Assist. Introduction. You may need to be familiar with AEMT and paramedic skills. These include: Advanced airway techniques Intravenous (IV) therapy Cardiac monitoring. Advanced Airway Techniques.

ephraim
Télécharger la présentation

Chapter 40

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chapter 40 ALS Assist

  2. Introduction • You may need to be familiar with AEMT and paramedic skills. • These include: • Advanced airway techniques • Intravenous (IV) therapy • Cardiac monitoring

  3. Advanced Airway Techniques • Establishing and maintaining an airway is the single most important EMT skill. • Most conscious patients can maintain their own airway. • Other patients may require an oropharyngeal or nasopharyngeal airway. • Advanced airway management provides better airway protection and ventilation.

  4. Anatomy and Physiology of the Airway (1 of 5) • The respiratory system consists of all the body structures used for breathing. • Upper airway includes the nose, mouth, throat (pharynx), and larynx (vocal cords). • Lower airway includes the trachea, bronchi, and lungs.

  5. Anatomy and Physiology of the Airway (2 of 5)

  6. Anatomy and Physiology of the Airway (3 of 5) • The respiratory system: • Delivers oxygen to body • Removes carbon dioxide • This process takes place on two levels: • Alveolar-capillary exchange • Capillary-cellular exchange

  7. Anatomy and Physiology of the Airway (4 of 5)

  8. Anatomy and Physiology of the Airway (5 of 5) • Each living cell of the body requires a regular supply of oxygen. • Some cells, such as those in the heart, brain, and nervous system, need a constant supply to survive. • Other cells can tolerate short periods without oxygen.

  9. Basic Airway Management (1 of 2) • Always assess the airway first in an injured or ill patient. • Open the airway. • Use the head tilt–chin lift maneuver in a patient with no suspected spinal injury. • Use the jaw-thrust maneuver if there is a possibility of spinal injury.

  10. Basic Airway Management (2 of 2) • Assess the airway and evaluate the need for suctioning to remove: • Foreign bodies • Liquid • Blood • Determine if the patient needs an airway adjunct.

  11. Endotracheal Intubation (1 of 2) • Insertion of a tube into the trachea to maintain the airway • If done through the mouth, it is called orotracheal intubation. • If done through the nose, it is called nasotracheal intubation. • Tube passes directly through the larynx between the vocal cords and trachea.

  12. Endotracheal Intubation (2 of 2) • Very effective method • Indicated for: • Patients who cannot protect their own airway • Patients who need prolonged artificial ventilation

  13. Equipment (1 of 8) • Assemble all the equipment. • Laryngoscope handle and blade • Properly sized endotracheal (ET) tube • Stylet • 10-mL syringe • Water-soluble lubricant for the ET tube • Suction unit with rigid and soft-tip catheters

  14. Equipment (2 of 8) • Assemble all the equipment (cont’d). • Magill forceps • Stethoscope • Commercial securing device • Secondary confirmation device

  15. Equipment (3 of 8) • Laryngoscope • Used to sweep the tongue out of the way and align the airway so the vocal cords can be visualized • Endotracheal tubes • Proper-sized tube for adults ranges from 7.0 to 8.5 mm

  16. Equipment (4 of 8)

  17. Equipment (5 of 8) • Endotracheal tubes (cont’d) • Use the largest-diameter ET tube that will pass easily through the vocal cords. • For children, use a resuscitation tape device. • A standard 15/22-mm adapter attaches to any ventilation device.

  18. Equipment (6 of 8)

  19. Equipment (7 of 8) • Stylet • Inserted into the ET tube to add rigidity and shape during intubation • Bend the tip to form a gentle curve. • Do not insert past Murphy’s eye.

  20. Equipment (8 of 8) • Syringe • Use a 10-mL syringe to test for air leaks in the ET tube before intubation. • Other equipment • A suction unit may be needed to clear secretions or blood. • A commercial securing device ensures that the tube does not move.

  21. The Sellick Maneuver • Can be used to intubate a patient who has no cough and/or gag reflex • Helps reduce the chance of regurgitation and aspiration of stomach contents • Follow the steps in Skill Drill 40-1. • Be sure to correctly identify anatomic landmarks.

  22. The Intubation Procedure (1 of 7) • You may intubate only if authorized by off-line or online medical control. • Be sure to use standard precautions. • An intubation attempt should not take more than 30 seconds. • Begins when ventilation stops and the laryngoscope blade is inserted • Ends when ventilation begins again

  23. The Intubation Procedure (2 of 7) • Intubation is a multiple-person task. • First EMT applies and uses the AED. • Second and third EMTs perform CPR at a ratio of 30 compressions to 2 ventilations. • Fourth EMT prepares and intubates the patient. • Follow the steps in Skill Drill 40-2 to perform orotracheal intubation.

  24. The Intubation Procedure (3 of 7) • You must use a secondary method of confirming proper tube placement. • Esophageal detector devices • End-tidal carbon dioxide detectors • Capnography monitors • These devices are not 100% guaranteed.

  25. The Intubation Procedure (4 of 7) • Source: The LIFEPAK® 15 defibrillator monitor courtesy of Physio-Control. Used with permission of Physio-Control, Inc., and according to the Material Release Form provided by Physio-Control.

  26. The Intubation Procedure (5 of 7) • Primary confirmation is: • Direct visualization of the tube passing through the vocal cords • Auscultating good bilateral breath sounds • Seeing the patient’s chest rise and fall with each ventilation • Never let go of the ET tube until it is secured.

  27. The Intubation Procedure (6 of 7) • Intubation complications • Intubating the right main stem bronchus • Intubating the esophagus • Aggravating spinal injury • Increased hypoxia • Patient vomiting

  28. The Intubation Procedure (7 of 7) • Intubation complications (cont’d) • Laryngospasm • Trauma • Mechanical failure • Patient intolerant of the endotracheal tube • Decrease in heart rate

  29. Multilumen Airways (1 of 4) • Advanced airways that do not require visualization of the vocal cords for placement • Examples include the Combitube and pharyngeotracheal lumen airway. The Combitube

  30. Multilumen Airways (2 of 4)

  31. Multilumen Airways (3 of 4) • Contraindications • Conscious or semiconscious patients with a gag reflex • Children younger than 14 years • Adults shorter than 5′ • Patients who have ingested a caustic substance • Patients who have an esophageal disease

  32. Multilumen Airways (4 of 4) • Removing the multilumen airway • If the patient will no longer tolerate the airway, it should be removed. • Remember that the patient will likely vomit when the airway is removed, so a suction unit must be readily available. • Simply deflate both balloon cuffs and gently remove the tube.

  33. Single Lumen Airway (1 of 3) • King LT airway • Single lumen airway that is blindly inserted into the esophagus • Consists of a curved tube with ventilation ports located between two inflatable cuffs • Intended in patients who are taller than 4′

  34. Single Lumen Airway (2 of 3) • Source: Courtesy of King Systems

  35. Single Lumen Airway (3 of 3) • Laryngeal mask airway • Consists of two parts: the tube and the mask or cuff • After blind insertion, the device molds and seals itself around the laryngeal opening by inflation of the mask.

  36. Gastric Tubes (1 of 2) • Sometimes a patient may require placement of a tube through the nose or mouth that extends into the stomach. • Cardiac arrest patients • A nasal or oral gastric tube relieves gastric distention. • May be used by ED staff to lavage the stomach in cases of overdose

  37. Gastric Tubes (2 of 2) • Proper placement can be confirmed by: • Aspiration of stomach contents with a syringe • Listening with a stethoscope as air is introduced into the tube with a syringe • Radiograph on arrival at the ED

  38. Continuous Positive Airway Pressure (1 of 3) • Used in breathing patients who are alert and able to follow commands and have reduced function of the alveoli due to: • Congestive heart failure • Chronic obstructive pulmonary disease • Asthma

  39. Continuous Positive Airway Pressure (2 of 3) • A tight-fitting mask is placed over the mouth and nose and connected to an oxygen source. • Delivers flow rates of at least 50 L/min • May be helpful in patients with severe respiratory distress

  40. Continuous Positive Airway Pressure (3 of 3) • Courtesy of Respironics, Inc., Murraysville, PA. All rights reserved.

  41. Intravenous Therapy • Develop a routine to follow as you assemble the appropriate equipment. • This will help you keep track of your equipment and the steps necessary to complete successful IV administration.

  42. Indications • Many medications used by ALS crews are given by the IV route. • A fluid bolus may be indicated for patients who: • Are dehydrated because of vomiting or excessive diarrhea • Have experienced blood loss because of hemorrhage

  43. Assembling the Equipment

  44. Choosing an IV Solution (1 of 3) • In the prehospital setting, the choice of IV solution is limited to: • Isotonic crystalloids • Normal saline • Lactated Ringer’s solution • D5W is often reserved for administering medication.

  45. Choosing an IV Solution (2 of 3) • Each IV solution bag is wrapped in a protective sterile plastic bag. • Guaranteed to remain sterile until the posted expiration date • Once the wrap is torn, the IV solution has a shelf life of 24 hours.

  46. Choosing an IV Solution (3 of 3) • The bottom of each bag has two ports: • An injection port for medication • An access port for connecting the administration set • The more common prehospital volumes are 1,000 mL and 500 mL.

  47. Choosing an Administration Set (1 of 3) • An administration set moves fluid from the IV bag into the patient’s vascular system. • Each set has a piercing spike protected by a plastic cover.

  48. Choosing an Administration Set (2 of 3) • Drip sets come in two primary sizes. • A microdrip set allows 60 gtt/mL. • A macrodrip set allows 10 to 15 gtt/mL.

  49. Choosing an Administration Set (3 of 3) • Preparing an administration set • Verify the solution and check for clarity. • To spike the bag with the administration set, follow the steps in Skill Drill 40-3. • Saline locks (buff caps) are a way to maintain an active IV site without running fluids through the vein.

  50. Catheters • Hollow, laser-sharpened needle inside a hollow plastic tube that is inserted into a vein • Select the catheter size based on the: • Need for the IV • Condition of the patient’s veins • Location for the IV

More Related