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Emergency Medical Technician Basic Refresher Curriculum

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Use rigid catheter when suctioning mouth of an infant or child ... Provides less volume than mouth-to-mask ... of nose, then lower mask over mouth and chin. ... – PowerPoint PPT presentation

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Title: Emergency Medical Technician Basic Refresher Curriculum


1
Emergency Medical Technician Basic Refresher
Curriculum
  • Module II Airway

2
Cognitive Objectives
  • Perform techniques to assure a patent airway
  • Describe the steps in performing the head-tilt
    chin-lift
  • Describe the steps in performing the jaw thrust
  • Describe the techniques of suctioning
  • Describe how to measure and insert an
    oropharyngeal (oral) airway
  • Describe how to measure and insert a
    nasopharyngeal (nasal) airway

3
Cognitive Objectives
  • Provide ventilatory support for a patient
  • Describe the steps in performing the skill of
    artificially ventilating a patient with a
    bag-valve-mask for one and two rescuers
  • Describe the steps in performing the skill of
    artificially ventilating a patient with a flow
    restricted, oxygen-powered ventilation device

4
Cognitive Objectives
  • Use oxygen delivery system components (nasal
    cannula, face mask, etc..)
  • Identify a non-rebreather face mask and state the
    oxygen flow requirements needed for its use
  • Identify a nasal cannula and state the flow
    requirements needed for its use

5
Affective Objectives
  • Explain the rationale for basic life support
    artificial ventilation and airway protection
    skills taking priority over most other life
    support skills
  • Explain the rationale for providing oxygenation
    through high inspired oxygen concentrations to
    patients who, in the past, may have received low
    concentrations

6
Psychomotor Objectives
  • Demonstrate the steps in performing the skill of
    artificially ventilating a patient with a
    bag-valve-mask for one and two rescuers
  • Demonstrate how to insert an oropharyngeal and
    nasopharyngeal airway
  • Demonstrate the use of a non-rebreather face mask
    and a nasal cannula
  • Demonstrate artificial ventilation of a patient
    with a flow restricted, oxygen powered
    ventilation device

7
Module II Airway
  • Opening the Airway
  • Head-tilt chin-lift when no neck injury
    suspected-review technique learned in BLS course
  • Jaw thrust when the EMT-Basic suspects spinal
    injury - review technique learned in BLS course
  • Assess need for suctioning

8
Techniques of Suctioning
  • Suction device should be inspected on a regular
    basis before it is needed.
  • A properly functioning unit with a gauge should
    generate 300 mm Hg vacuum.
  • A battery operated unit should have a charged
    battery.

9
Techniques of Suctioning
  • Turn on the suction unit
  • Attach a catheter
  • Use rigid catheter when suctioning mouth of an
    infant or child
  • Often will need to suction nasal passages should
    use a bulb suction or French catheter with low to
    medium suction
  • Insert the catheter into the oral cavity without
    suction, if possible. Insert only to the base of
    the tongue.

10
Techniques of Suctioning
  • Apply suction
  • Move the catheter tip side to side
  • Suction for no more than 15 seconds at a time
  • In infants and children, shorter time should be
    used
  • If the patient has secretions or emesis that
    cannot be removed quickly and easily by
    suctioning, the patient should be logged rolled
    and the oropharynx should be cleared

11
Techniques of Suctioning
  • Suction for no more than 15 seconds at a time
  • If patient produces frothy secretions as rapidly
    as suctioning can remove, suction for 15 seconds,
    artificially ventilate for two minutes, then
    suction for 15 seconds, and continue in that
    matter. Consult medical direction for this
    situation
  • If necessary, rinse the catheter and tubing with
    water to prevent obstruction of the tubing from
    dried material

12
Techniques of Artificial Ventilation
  • In order of preference, the methods for
    ventilating a patient by the EMT-Basic are as
    follows
  • Mouth-to-mask with supplemental oxygen
  • Two person bag-valve-mask
  • Flow restricted, oxygen powered ventilation
    device
  • One person bag-valve-mask
  • EMTs must be aware of the difficulty of a single
    rescuers maintaining an adequate mask-to-face
    seal and delivering an adequate inspiratory volume

13
Techniques of Artificial Ventilation
  • Ensure BSI or body substance isolation
  • Bag-valve-mask
  • The bag-valve-mask consists of a self-inflating
    bag, one way valve, face mask, oxygen reservoir.

  • The bag must be connected to oxygen to perform
    most effectively

14
Bag-Valve-Mask
  • Volume of approximately 1600 mls
  • Provides less volume than mouth-to-mask
  • EMT-Basics working alone may have difficulty
    maintaining an airtight seal
  • Two EMT-Basics using the device will be more
    effective

15
Bag-Valve-Mask
  • Position self at top of patients head for
    optimal performance
  • Adjunctive airways (oral or nasal) may be
    necessary in conjunction with bag-valve-mask

16
BVM Use Without Trauma
  • After opening the airway, select correct mask
    size (adult, infant, or child).
  • Position thumbs over top half of mask, index and
    middle fingers over the bottom half.
  • Place apex of mask over bridge of nose, then
    lower mask over mouth and chin. If mask has
    large round cuff surrounding a ventilation port,
    center port over mouth.

17
BVM Use Without Trauma
  • Use ring and little fingers to bring jaw up to
    mask
  • Connect bag to mask if not already done
  • Have assistant squeeze bag with two hands until
    chest rises
  • If alone, form a C around the ventilation port
    with thumb and index finger, use middle, ring and
    little fingers under jaw to maintain chin lift
    and complete the seal

18
BVM Use Without Trauma
  • Repeat a minimum of every 5 seconds for adults
    and every 3 seconds for children and infants
  • If chest does not rise and fall, re-evaluate
  • Reposition head if chest does not rise
  • Reposition fingers and mask to get a good seal
  • Check for obstruction
  • Use alternative method (pocket mask) if still no
    chest rise

19
BVM Use Without Trauma
  • If necessary, consider use of adjuncts
  • Oral airway
  • Nasal airway
  • Dual lumen airway

20
BVM Use with Suspected Trauma
  • Open airway, select correct mask size
  • Immobilize head and neck
  • Have assistant hold head or place head between
    knees
  • Position thumbs over top half of mask, index and
    middle over bottom half
  • Place apex of mask over bridge of nose, then
    lower mask over mouth and upper chin. If mask
    has large round cuff with ventilation port,
    center port over mouth.

21
BVM Use with Suspected Trauma
  • Use ring and little fingers to bring jaw up to
    mask without tilting head or neck
  • Connect bag to mask if not already done
  • Have assistant squeeze bag with two hands until
    chest rises

22
BVM Use with Suspected Trauma
  • Repeat every 5 seconds for adults and every 3 for
    children and infants, continuing to hold jaw up
    without moving head or neck

23
BVM Use with Suspected Trauma
  • If chest does not rise, re-evaluate
  • If abdomen rises, reposition jaw
  • If air is escaping from under the mask,
    reposition fingers and mask
  • Check for obstruction
  • If chest still does not rise, use alternate
    method
  • Consider use of adjuncts
  • Oral or nasal airway

24
Flow Restricted, Oxygen-Powered Ventilation
Devices
  • For adult use only and should provide
  • A peak flow rate of 100 oxygen at up to 40 lpm
  • An inspiratory pressure relief valve that opens
    at approximately 60 centimeters water and vents
    any remaining volume to the atmosphere or ceases
    gas flow

25
Flow Restricted, Oxygen-Powered Ventilation
Devices
  • An audible alarm that sounds whenever the relief
    valve pressure is exceeded
  • Satisfactory operation under ordinary
    environmental conditions and extremes of
    temperature
  • A trigger positioned so that both hands of the
    EMT-Basic can remain on the mask to hold it in
    position

26
FROPVD Use Without Trauma
  • After opening airway, insert correct size oral or
    nasal airway and attach adult mask
  • Position thumbs over top half of mask, index and
    middle over bottom half
  • Place apex of mask over bridge of nose, then
    lower mask over mouth and chin
  • Use ring and little fingers to bring jaw up to
    mask

27
FROPVD Use Without Trauma
  • Connect flow restricted, oxygen powered
    ventilation device to mask if not already done
  • Trigger the FROPVD until chest rises
  • Repeat every 5 seconds
  • Consider use of adjuncts

28
FROPVD Use Without Trauma
  • If chest does not rise, re-evaluate
  • If abdomen rises, reposition head
  • If air is escaping from under the mask,
    reposition fingers and mask
  • Check for obstruction
  • If chest still does not rise, use alternative
    method of artificial ventilation (e.g. pocket
    mask)

29
Use When Neck Injury is Suspected
  • After opening airway, attach adult mask
  • Immobilize head and neck
  • Position thumbs over top half of mask, index and
    middle over bottom half
  • Place apex of mask over bridge of nose, then
    lower mask over mouth and upper chin

30
Use When Neck Injury is Suspected
  • Use ring and little fingers to bring jaw up to
    mask without tilting head or neck
  • Connect flow restricted, oxygen powered
    ventilation device to mask
  • Trigger the FROPVD until chest rises

31
Use When Neck Injury is Suspected
  • Repeat every 5 seconds
  • Consider use of adjuncts
  • If chest does not rise and fall
  • Reposition jaw and check seal
  • Check for obstruction
  • If chest still does not rise, use alternative
    method of artificial ventilation

32
Airway Adjuncts
  • Oropharyngeal (oral) airways
  • Oropharyngeal airways may be used to assist in
    maintaining and open airway on unresponsive
    patients without a gag reflex
  • Select the proper size measure from the corner
    of the patients lips to the bottom of he earlobe
    or angle of jaw

33
Oropharyngeal Airways
  • Insertion of oropharyngeal airway
  • Open the patients mouth
  • To avoid obstructing he airway with tongue,
    insert the airway upside down

34
Oropharyngeal Airways
  • Advance the airway gently until resistance is
    encountered. Turn the airway 180 degrees so that
    it comes to rest with the flange on the patients
    teeth
  • Another method is right side up, using a tongue
    depressor to press the tongue down and forward to
    avoid obstructing the airway. This is the
    preferred method for airway insertion in an
    infant or child.

35
Nasopharyngeal (Nasal) Airways
  • Nasopharyngeal airways are less likely to
    stimulate vomiting and may be used on patients
    who are responsive but need assistance keeping
    the tongue from obstructing the airway
  • Even though the tube is lubricated, this is a
    painful stimulus

36
Nasopharyngeal (Nasal) Airways
  • Select the proper size, measure from the tip of
    the nose to the tip of the patients ear
  • Consider diameter of the nare
  • Lubricate the airway with a water soluble
    lubricant

37
Nasopharyngeal (Nasal) Airways
  • Insert it posteriorly
  • Bevel should be toward base of the nare or toward
    the septum
  • If the airway cannot be inserted into one
    nostril, try the other nostril

38
Oxygen Equipment for Delivery
  • Non-rebreather mask
  • Preferred method of giving oxygen to prehospital
    patients
  • Up to 90 oxygen can be delivered
  • Non-rebreather bag must be full before mask is
    placed on patient
  • Flow rate should be adjusted so that when patient
    inhales, bag does not collapse (15 lpm)

39
Oxygen Equipment for Delivery
  • Patients who are cyanotic, cool, clammy, or short
    of breath need oxygen
  • Patients with chronic obstructive pulmonary
    disease and infants and children who require
    oxygen should receive high concentration oxygen
  • Be sure to select the correct mask size

40
Oxygen Equipment for Delivery
  • Nasal Cannula
  • Rarely the best method of delivering adequate
    oxygen to the pre-hospital patient
  • Should only be used when patients will not
    tolerate a non-rebreather mask

41
Airway Management Dual Lumen Airway
42
Cognitive Objectives
  • Describe the equipment needed for inserting a
    dual lumen airway.
  • Describe the indications for using a dual lumen
    airway.
  • Explain the contraindications for using a dual
    lumen airway.
  • Identify the advantages of a dual lumen airway.

43
Cognitive Objectives
  • Identify the disadvantages of a dual lumen
    airway.
  • Describe the complications associated with a dual
    lumen airway device.
  • Describe the technique for inserting a dual lumen
    airway device.
  • Describe the technique for removing a dual lumen
    airway device.

44
Affective Objectives
  • Explain the rationale for basic life support
    artificial ventilation and airway protective
    skills taking priority over most other basic life
    support skills.
  • Explain the rationale for inserting a dual lumen
    airway device over other basic airway skills.

45
Psychomotor Objectives
  • Demonstrate how to insert a dual lumen airway
    device.
  • Demonstrate how to remove a dual lumen airway
    device.

46
Dual Lumen Airway Devices
  • The following are the two dual lumen airway
    devices approved for use by ADPH-EMS
  • Pharyngeo-tracheal lumen airway (PTL)
  • Combitube

47
Combitube
48
(No Transcript)
49
Combitube
  • Indications
  • Use only in patients who are unresponsive and
    without protective reflexes gag reflex.
  • For Paramedics use only in patients that you are
    unable to insert an endotracheal tube.
  • Patients in cardiac or respiratory arrest.

50
Combitube
  • Contraindications
  • Less 16 years of age
  • Under five feet in height
  • Intact gag reflex
  • Known esophageal disease
  • Ingestion of a caustic substance

51
Combitube
  • Insertion Technique
  • Hyperventilate the patient at a rate of 24 times
    per minute for at least 2 minutes before
    attempting insertion, an oropharyngeal airway
    should be utilized in this time.
  • Assemble equipment, ensure that cuffs are not
    leaking, and lubricate the distal end of the tube
    with water-soluble lubricant.

52
Combitube
  • Insertion Technique
  • Place the patients head in a neutral in-line
    position. If spinal injury is suspected maintain
    the head in a neutral in line position.
  • Perform a tongue-jaw lift maneuver and insert the
    device until the teeth are between the two black
    rings.

53
Combitube
  • Insertion Technique
  • Use the large syringe to inflate the 1
    pharyngeal cuff with 100cc of air. The pharynx
    will be sealed once this cuff is inflated.
  • Inflate the 2 distal cuff with 15cc of air.
    This will seal the esophagus or trachea depending
    on placement.

54
Combitube
  • Insertion Technique
  • Ventilate through the longer 1 ventilation tube.
    During ventilation, auscultate over the
    epigastrum and listen for gurgling sounds.
  • If no sounds are heard, watch for chest rise and
    auscultate chest for breath sounds.

55
Combitube
  • Insertion Technique
  • If equal chest rise and breath sounds bilaterally
    are present, then continue to ventilate through
    the tube 1.
  • If you hear gurgling sounds in the stomach then
    assume that you have inserted the device in the
    trachea and start to ventilate through the 2
    tube.

56
Combitube
  • Insertion Technique
  • Auscultate over the epigastrum, if gurgling is
    heard then remove the tube and ventilate patient
    with BVM.
  • If no gurgling is heard then auscultate breath
    sounds, if the breath sounds are equal
    bilaterally then continue to ventilate through
    the 2 tube.

57
Combitube
  • Insertion Technique
  • Once placement is confirmed hyperventilate the
    patient for two minutes, then resume normal
    ventilation.
  • Reassess the tube placement after each patient
    move, and periodically check the pilot balloons
    to ensure that the two cuffs are adequately
    inflated.

58
Combitube
  • Removal Technique
  • Have suction equipment ready for use.
  • Deflate both cuffs and remove tube gently.
  • Be alert for vomiting.
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