1 / 22

CBT 2008

CBT 2008. Mickey Eisenberg, MD, PhD Medical Program Director. Key Points for 2009. 1. Meticulous CPR is Critical. Minimize hands-off time This keeps the left ventricle filled with blood which keeps the coronary perfusion pressure high which makes a defibrillatory shock successful

georgiaharrison
Télécharger la présentation

CBT 2008

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. CBT 2008 Mickey Eisenberg, MD, PhD Medical Program Director

  2. Key Points for 2009

  3. 1. Meticulous CPR is Critical • Minimize hands-off time • This keeps the left ventricle filled with blood which keeps the coronary perfusion pressure high which makes a defibrillatory shock successful • Attention to details makes a difference

  4. 2008 Survival • 48.5% • Goal is 50%

  5. 2. Always Take Vital Signs • Every patient MUST have BP, pulse, and RR • Only exceptions: • DOA patients (BP is not needed) • Pediatric patients (BP not immediately required) use Pediatric Assessment Triangle (PAT) • Patient assist calls with absolutely no patient assessment or clinical decision making

  6. 3. Abnormal Vital Signs MUSTbe Addressed • What is abnormal? • BP > 160/110 • Pulse > than 100-120 • RR > than 20 • All in the appropriate clinical setting

  7. 4. Physical MUST Match the Complaint • Headache requires neurological exam • GI complaint requires abdominal exam • SOB requires lung exam • And so on

  8. 5. Patients left at home MUST have documentation of instructions • You MUST indicate on MIRF that the patient was informed to seek medical care or call 911 if not improved or symptoms worsen

  9. 6. Inform Patients of Options • Transportation options should be discussed with patients. • FD transport • Private ambulance (inform patient of charges) • Taxi • Family member, friend • Document that you did so

  10. 7. You MUST Include Verified Phone and Address in Computer • King County EMS contacts many patients by mail or phone • We MUST have a valid address and best-contact phone number • We MUST spell the patient’s name correctly!! • These MUST be entered in the computer

  11. 8. Sick/Not Sick MUST be Applied to Every Patient. • Critical thinking MUST be applied to every patient • This is the basis for our entire EMS system • Always consider MOI, NOI, and IOS

  12. 9. You MUST Document Your Actions • All procedures (glucometry, oximetry, CPR, oxygen, ASA administration) MUST be documented – on MIRF and in computer • If it isn’t on the MIRF or in the computer it didn’t happen • All hypoglycemia patients MUST have before treatment and after treatment glucometry • After care instructions MUST be left with patient if patient is left at scene

  13. 10. SPHERE Alerts Make a Difference • EMTs have handed out thousands of Alert Cards for patients with high blood pressure and high blood sugar • This is a real service • Encourage your EMTs to keep doing this and do what you can to facilitate Alert Cards • Remember to check the boxes on the MIRF and enter into the computer

  14. MIRF

  15. EMS Online – Sphere Cards

  16. 11. Be Safe! • Getting to scene • At scene • During transportation • Your health

  17. Plans for 2009 • Continued attention to details of CPR and defibrillation • Emphasis on rapid assessment and transport of acute MI patients by paramedics • Emphasis on EMT administration of aspirin for patients with ACS • Emphasis on rapid assessment and transport of stroke patients by EMTs (Code CVA) • Left at scene documentation • Creation of EMT Advisory Group

  18. Study Updates • ROC study keys on BLS care and performance • Correct compliance with ITD valve and • analyze early versus analyze late. • King County has set the standard for study performance: • 99% compliance with contacting study nurses • 85% correct compliance with AE/AL assignment • 85% compliance and early ITD valve placement • 80% AED downloads • All the while achieving the highest survival among sites……. • (This high study performance and superior survival is not a • chance coincidence but a tribute to training, effort, and skills)

  19. Study Updates • Enrolled 6000 patients study wide…1500 from King County • Next switch from AE vs. AL scheduled for mid-March, 2009 • Be aware that the paramedics will be infusing cold IV fluid in some resuscitated patients as part of the Hypothermia Study. You may be able to help by grabbing and preparing the cold fluid from the medic unit refrigerators. • In conclusion, still opportunities to make incremental • improvement in particular cases, but over all care is very solid and sets the standard for other EMS systems. • Thank you…….and keep pushing.

  20. Thank You

More Related