Condell Medical Center EMS System

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Condell Medical CenterEMS System

• Case Review Studies
• September 2004

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Case Study 1

• You are on the scene of a patient with an NG tube
  that had been inserted due to difficulty
  swallowing following a stroke. Medical control
  has authorized you to assist the family in
  administering medication via the NG tube.
• How would you carry out this task?

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Case Study 1 continued

• Determine the 6 patient rights in regards to
  medication
• ?right patient
• ? right drug
• ? right dose
• ? right time
• ? right route
• ? right documentation

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Case Study 1 continued

• Assist the family in crushing the medication into
  a fine powder
• Determine correct NG tube placement
• inject 30-50 ml of air into the proximal end of
  the NG tube
• auscultate for a popping sound over the
  epigastric area
• Administer the medication followed by a flush
  with water or normal saline

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Case Study 2

• A 23 year-old construction worker walks into your
  station with a complaint of a foreign body
  sensation in their right eye.
• In respect to the complaint, what would
  constitute an appropriate evaluation of the eye
  for the EMS provider to do?

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Case Study 2 continued

• Perform gross visual exam of the eye - take a
  look
• Perform a visual acuity
• count fingers
• read printed material
• Could evert eyelid looking for a foreign body
• Could flush the eye

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Case Study 2 continued

• Would helpful information be gained by checking
  the pupil with a penlight in this situation?
• Would checking the 6 cardinal directions of gaze
  provide helpful information in this situation?

• Evaluating for the light reflex (ie PERL) and
  evaluating the 6 cardinal directions of gaze are
  evaluations of cranial nerves III, IV, and VI and
  are used to check for neurological problems not
  for foreign bodies.

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Case Study 3

• Your adult patient was involved in a motor
  vehicle crash prior to your arrival. The patient
  appears to have struck their neck on the steering
  wheel. They are apneic and have a weak pulse.
  You are unable to ventilate this apneic patient
  with a BVM.
• What would be your appropriate course of action?

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Case Study 3 continued

• Which would provide more tidal volume?
• translaryngeal cannula ventilation
• needle cric
• OR
• surgical cricothyrotomy

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Case Study 3 continued

• Prepare equipment to perform a surgical
  cricothyrotomy on this patient
• One person should be preparing/assembling the kit
  material
• The paramedic elected to perform the skill should
  be identifying landmarks and prepping the site

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Case Study 3 continued

• What are the landmarks of the cricothyroid
  membrane - how do you find it?

• Palpate the thyroid cartilage or Adams apple
• Palpate the cricoid ring below the Adams apple
• Palpate the soft membrane in between - this is
  the cricothyroid membrane

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Case Study 3 continued

• The surgical cricothyrotomy is performed
• The airway catheter is in place
• What should be the next immediate action taken?

• The patient should be bagged with the BVM at a
  rate similar to other intubated patients needing
  to be bagged
• Assess for bilateral breath sounds
• Secure the airway catheter with the ties provided

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Case Study 4

• You have a 10 year-old patient with a totally
  blocked upper airway. How would you handle this
  situation?

• Always start with basic maneuvers
• heimlich maneuver / abdominal thrusts
• Can you see anything with a laryngoscope blade
  that can be reached out with a magill forceps?

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Case Study 4 continued

• The airway remains blocked. Time is running out.
  Can you perform a surgical cricothyrotomy on this
  patient?

• ?A surgical cricothyrotomy can be performed on
  any patient in which you are still able to
  identify landmarks
• ?This patient will certainly die if no
  interventions are attempted

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• Questions?

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Contributing NIEMSCA Authors to September CE
Packet

• Lonnie Polhemus, EMT-P
• Brain Sobeck BA, NREMT-P
• Program modification completed by
• Sharon Hopkins, RN, BSN, EMT-P