Welcome! DOT National Standard EMT-Intermediate/85 Refresher
MEDICAL EMERGENCIES • Allergic reaction • Possible overdose • Near-drowning • ALOC • Diabetes
MEDICAL EMERGENCIES • ■ Assess and provide care to a patient experiencing a seizure • ■ Assess and provide care to a patient exposed to heat or cold • ■ Assess and provide care to a patient experiencing a behavioral problem • ■ Assess and provide care to a patient with suspected communicable disease
Airway, Breathing & Circulation • ■ Provide ventilatory support for a patient • ■ Attempt to resuscitate a patient in cardiac arrest • ■ Provide care to a patient experiencing cardiovascular compromise • ■ Provide post resuscitation care to a cardiac arrest patient
BEHAVIORAL EMERGENCIES Perspective Pathophysiology Epidemiology PE & Diagnostic Findings S/S Differential considerations Tx MEDICAL EMERGENCIES
perspective • You & your EMT partner respond with an engine company to a “rollover accident” 3 of the girls are ambulatory, you find that a small sedan carry 4 college-aged girls has rolled over.
perspective • 3 of the girls are ambulatory; the 4th is trapped, with her hips lying under the car. She is unresponsive to deep pain & is lying on her side. • Her skin is pale & warm. Her respirations are shallow at 12/ min & her pulse is irregular & difficult to palpate at 88 beats/min. The engine company can safely remove her in 10 minutes
perspective • What is your general impression of this pt? • What additional assessment will be important in the evaluation of this pt? Can you complete any assessments before extrication? • What interventions should you initiate this time?
Pathophysiology • Ventilatory support • Minute volume = tidal x respiratory rate • Tidal volume is the lung volume representing the normal volume of air displaced between normal inspiration and expiration when extra effort is not applied. Typical values are around 500ml or 7ml/kg bodyweight
Epidemiology • Ventilatory support can be for a deficit of tidal volume or rate • Tidal volume that is too low is problematic • Rate that is too high or too low is problematic
Epidemiology • Ventilatory support is usually achieved using • BVM with or without adjuncts (NPA or OPA) • Advanced airway insert: King or Combitube • CPAP • Transtracheal Jet Insufflation • Always be ready to suction
BVM with or without adjuncts (NPA or OPA) • Head & neck position are vital • Head & neck must midline • Head-tilt • Jaw thrust • Jaw thrust & head tilt • Be ready to suction
NPA • Right nare larger • Bevel toward septum • Size it correctly • lubrication
NPA • Indication -- can’t use an OPA • Contraindication • severe head or facial injuries, or have evidence of a basilar skull fracture (Battle's sign, raccoon eyes, cerebrospinal fluid/blood from ears, etc.) due to the possibility of direct intrusion upon brain tissue. • An OPA may be used instead, but these devices frequently trigger a patient's gag reflex, while nasopharyngeal airways usually do not.
OPA • Indications: unconscious & no gag reflex • Sizing • Insertion: rotation or tongue depressor • Does not definitively protect from aspiration
BVM • Apneic or inadequate ventilation • Positive pressure ventilations (PPV) • Mouth-to-mouth ventilation • Mouth-to-nose ventilation • Mouth-to-barrier device ventilation • Mouth-to-mask ventilation • Rate AND Depth are important
BVM • Gastric distention • Mask to face seal • Sellick’s maneuver?
Combitube • Allows ventilation of lungs & reduces the risk of aspiration • 37F- 4-5feet • 41F- >5feet • Page 17/260 procedure
Combitube • When teeth/gum line located between black lines
King • Size 3 - 4-5 feet • Size 4 - 5-6feet • Size 5- >6feet • Page 33/260 procedure
COPD • Hypoxic drive to breathe
Wheezing • Rales • Rhochi • Stridor
LS • Right & left fields • Upper & lower fields • Expiratory &/or inspiratory sounds
Questions? • References • Marx, John A. ed, Hockberger & Walls, eds et al. Rosen’s Emergency Medicine Concepts and Clinical Practice, 7th edition. Mosby & Elsevier, Philadelphia: PA 2010. • Tintinalli, Judith E., ed, Stapczynski & Cline, et al. Tintinalli’s Emergency Medicine A Comprehensive Study Guide, 7th edition. The McGraw-Hill Companies, Inc. New York 2011. • Wolfson, Allan B. ed. , Hendey, George W.; Ling, Louis J., et al. Clinical Practice of Emergency Medicine, 5th edition. Wolters Kluwer & Lippincott Williams & Wilkings, Philadelphia: PA 2010.