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EMERGENCY MEDICAL TECHNICIAN

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Suctioning Purpose Devices Measurement Time Procedure Airway Management Airway Management Artificial Ventilations Adjuncts-name, measure, ... – PowerPoint PPT presentation

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Title: EMERGENCY MEDICAL TECHNICIAN


1
EMERGENCY MEDICAL TECHNICIAN
  • Review 1st half
  • Compiled by Barry Barkinsky EMS-I

2
Preparatory
3
The EMS System
  • Components of the
  • Emergency Medical
  • Services (EMS) System

4
System Access
  • Enhanced 911
  • 911
  • Non-911

5
Bystanders
6
Emergency Medical Dispatcher
7
First Responders
8
Emergency Medical Technician-Basic
9
Advanced Life Support (ALS)
10
Emergency Department Staff
11
Specialty Facilities
  • Trauma Centers
  • Burn Centers
  • Pediatric Centers
  • Poison Control Centers

12
Roles and Responsibilities
  • Scene Safety
  • Patient Assessment / Care
  • Lifting and Moving
  • Transport / Transfer of Care
  • Documentation
  • Patient Advocacy

13
Quality Improvement
  • Provides documentation
  • Reviews audits runs
  • Gathers feedback from patients hospital staff
  • Conducts preventive maintenance
  • Continues education
  • Maintains skills

14
Medical Direction
  • Medical Director
  • Sponsor Hospital
  • Medical Direction
  • On-Line radio, phone patch
  • Off-Line standing orders

15
Well - Being
16
Well Being of the EMT
  • Emotion and Stress
  • Scene safety
  • Exposure Control Plan
  • Lifting and Moving

17
Emotion and Stress
  • Causes
  • Signs and Symptoms
  • Dealing with Stress
  • CISD
  • Understanding of Death and Dying

18
Scene Safety
Scene safety starts on arrival and continues
throughout the call!
19
Medical / Legal
What is ?
20
Medical / Legal
  • Scope of Practice

21
Medical / Legal
  • Expressed Consent

22
Medical / Legal
  • Implied Consent

23
Medical / Legal
  • DNR

24
Medical / Legal
  • LIVING WILL

25
Medical / Legal
  • Abandonment

26
Medical / Legal
  • Negligence

27
Medical / Legal
  • Refusal

28
Medical / Legal
  • Special Reporting Situations

29
Medical / Legal
  • Crime Scene

30
DOCUMENTATION
31
Documentation
  • Your written prehospital care report (PCR) is the
    only true factual record of events.
  • Your PCR is your sole permanent, complete written
    record of events during the ambulance call.

32
Uses for PCRs
  • Medical
  • Administrative
  • Research
  • Legal

33
General Considerations
  • Use appropriate medical terminology.
  • Use acceptable and approved abbreviations and
    acronyms.

If you do not know how to spell a word, look it
up or use another word
34
Communications
  • The communications with the hospital are another
    important item to document.
  • Document ANY medical advice or orders you receive
    and the results of implementing that advice and
    those orders.

35
Pertinent Negatives
  • Document all findings of your assessment, even
    those that are normal.
  • Remember you are building a case to support your
    clinical impression

36
Oral Statements
  • Whenever possible, quote the patientor other
    source of informationdirectly.

Example Bystanders state the patient was acting
bizarre and threatening to jump in front of the
next passing car.
37
Elements of Good Documentation
  • Accuracy
  • Legibility
  • Timeliness
  • Absence of alterations
  • Professionalism

38
Professionalism
  • Never include slang, biased statements, or
    irrelevant opinions.
  • Include only objective information.
  • Always write and speak clearly.

39
Narrative Writing
  • Subjective part of your narrative comprises any
    information that you elicit during your patients
    history.
  • Objective part of your narrative usually includes
    your general impression and any data that
    you derive through inspection, palpation,
    auscultation, percussion, and diagnostic testing.

40
Special Considerations
  • Patient refusals
  • Services not needed
  • Mass casualty incidents

41
Patient Refusals
  • Patients retain the right to refuse treatment or
    transportation if they are competent to make that
    decision.
  • Two main types of refusals
  • Person who is not seriously injured and does
    not want to go to the hospital
  • The patient refuses even though you feel he
    needs it. Also known as AMA

42
A patients refusal of care requires careful
documentation.
43
Airway Management
44
Airway Management
  • Anatomy

45
Airway Management
  • Upper Airway
  • Comprised of?

46
Airway Management
47
Airway Management
  • Lower Airway

48
Airway Management
49
Airway Management
  • Opening the Airway
  • - No trauma

50
Airway Management
  • Opening the Airway (Trauma)

51
Airway Management
  • Breathing
  • Ventilation versus oxygenation

52
Airway Management
  • Signs and Symptoms
  • Adequate / Inadequate Breathing
  • Can you list them?

53
Airway Management
  • Suctioning
  • How, how long?

54
Suctioning
  • Purpose
  • Devices
  • Measurement
  • Time
  • Procedure

55
Airway Management
56
Airway Management
  • Artificial Ventilations
  • Adjuncts-name, measure, insert
  • Oxygen devices

57
Non-Invasive Respiratory Monitoring
58
Pulse Oximeter
59
PATIENT ASSESSMENT
60
BSI
  • B Body
  • S Substance
  • I Isolation

61
MOI / NOI
  • M Mechanism
  • O of
  • I Injury
  • N Nature
  • O of
  • I Illness

62
SAMPLE
  • S Signs and Symptoms
  • A Allergies
  • M Medications
  • P Past Medical History
  • L Last Oral Intake
  • E Events Leading to the Injury / Illness

63
OPQRST
  • O Onset
  • P Provocation
  • Q Quality
  • R Radiation
  • S Severity
  • T Time

64
DCAP-BTLS
  • D Deformity
  • C Contusions
  • A Abrasions
  • P Punctures / Penetrations
  • B Burns
  • T Tenderness
  • L Lacerations
  • S Swelling

65
Baseline Vital Signs
  • Respirations
  • Pulse
  • Skin
  • Pupils
  • Blood Pressure
  • Pulse Ox
  • Temperature

66
Ongoing Assessment
  • Repeat Initial Assessment
  • Reassess Vital Signs
  • Repeat Focused Assessment
  • Check Interventions

67
Ongoing Assessment
  • Stable Patient
  • How often?

68
Ongoing Assessment
  • Unstable Patient
  • How often?

69
Rapid Trauma Assessment (Check for DCAP-BTLS)
  • Head
  • Neck
  • Chest
  • Abdomen
  • Pelvis
  • Extremities (PMS)
  • Posterior

70
Head DCAP-BTLS
71
Ears DCAP-BTLS Drainage
72
Neck DCAP-BTLS Jugular Vein Distention and
Crepitation
73
Chest DCAP-BTLS Crepitation and Breath Sounds
(Presence and Equality)
74
Listen to both sides of the chest. Is air entry
present? Absent? Equal on both sides? Compare
left side to right side.
Mid-clavicular
Mid-axillary
75
Abdomen DCAP-BTLS Firmness and Distention
76
Pelvis DCAP-BTLS (Compress Gently)
77
Extremities DCAP-BTLS Distal Pulse, Sensation,
Motor Function
78
Posterior DCAP-BTLS
79
TYPES OF PATIENTS
80
Medical Patient
  • Scene Size Up
  • Safety
  • BSI
  • MOI / NOI
  • Patients / Resources

81
Medical Patient Responsive Patient
  • Initial
  • General Impression
  • Mental Status
  • ABCs
  • Priority of Patient

82
Medical Patient Responsive Patient
  • Focused History and Physical Exam
  • Physical Exam
  • OPQRST
  • SAMPLE

83
Medical Patient Unresponsive Medical Patient
  • Initial
  • ABCs
  • Rule out Trauma
  • Focused Exam
  • Rapid Assessment
  • Vitals / SAMPLE
  • Ongoing

84
Patient Assessment Trauma Patient
  • Determine MOI
  • Significant / Non-Significant
  • Initial Assessment
  • ABCs
  • Patient priority
  • Focused History and Physical Exam
  • DCAP- BTLS
  • Rapid trauma assessment

85
Patient Assessment Trauma Patient
  • Rapid Trauma Assessment
  • C-Collar
  • Inspect, palpate, auscultate
  • DCAP-BTLS
  • SAMPLE
  • Detailed Exam
  • Ongoing

86
Patient Assessment Trauma Patient
  • Rapid Trauma Assessment
  • C-Collar
  • Inspect, palpate, auscultate
  • DCAP-BTLS
  • SAMPLE
  • Detailed Exam
  • Ongoing

87
Trauma Patient No Significant MOI
  • Initial Assessment
  • Focused History and Physical Exam
  • Ongoing Assessment

88
Pharmacology
89
Pharmacology
  • Medications on Ambulance
  • Oxygen, charcoal oral glucose,

90
Pharmacology
  • Prescribed Medications
  • Which ones can you assist the patient in taking?
    After what?

91
Pharmacology
  • Indications

92
Pharmacology
  • Contraindications

93
Pharmacology
  • The 4 Rights to Med Administration

94
Medical Emergencies
  • Seizures

95
Seizures
  • Generalized Seizures
  • Tonic-Clonic
  • Aura
  • Loss of Consciousness
  • Tonic Phase
  • Clonic Phase
  • Postseizure
  • Postictal

96
Seizures
  • Partial Seizures
  • Simple Partial Seizures
  • Involve one body area.
  • Can progress to generalized seizure.
  • Also known as focal seizures
  • Complex Partial Seizures
  • Characterized by auras.
  • Typically 12 minutes in length.
  • Loss of contact with surroundings.

97
Seizures
  • Assessment
  • Differentiating Between Syncope Seizure
  • Bystanders frequently confuse syncope and seizure.

98
Seizures
  • Management
  • Scene safety BSI.
  • Maintain the airway.
  • Administer high-flow oxygen.
  • Treat hypoglycemia if present.
  • Do not restrain the patient.
  • Protect the patient from the environment.
  • Maintain body temperature.

99
Seizures
  • Management
  • Position the patient.
  • Suction if required.
  • Provide a quiet atmosphere.
  • Transport.

100
Seizures
  • Status Epilepticus
  • Two or More Generalized Seizures
  • Seizures occur without a return of consciousness.
  • Management
  • Management of airway and breathing is critical.
  • Monitor the airway closely.

101
Medical Emergencies
  • Stroke (CVA)

102
Stroke Intracranial Hemorrhage
  • Occlusive Strokes
  • Embolic Thrombotic Strokes
  • Hemorrhagic Strokes

103
Stroke Intracranial Hemorrhage
  • Signs
  • Facial Drooping
  • Headache
  • Aphasia/Dysphasia
  • Hemiparesis
  • Paresthesia
  • Gait Disturbances
  • Incontinence

Symptoms Confusion Agitation Dizziness Vision
Problems
104
Stroke Intracranial Hemorrhage
  • Transient Ischemic Attacks
  • Indicative of carotid artery disease.
  • Symptoms of neurological deficit
  • Symptoms resolve in less than 24 hours.
  • No long-term effects.
  • Evaluate through history taking
  • History of HTN, prior stroke, or TIA.
  • Symptoms and their progression.

105
Stroke Intracranial Hemorrhage
  • Management
  • Scene safety BSI
  • Maintain the airway.
  • Support breathing.
  • Obtain a detailed history.
  • Position the patient.
  • Protect paralyzed extremities.

106
Medical Emergencies
  • Allergic Reaction (Anaphylaxis)

107
Allergies and Anaphylaxis
  • Allergic Reaction
  • An exaggerated response by the immune system to a
    foreign substance
  • Anaphylaxis
  • An unusual or exaggerated allergic reaction
  • A life-threatening emergency
  • The most severe form of allergic reaction

108
Anaphylaxis
  • Causes

109
Assessment Findings in Anaphylaxis
  • Focused History Physical Exam
  • Focused History
  • SAMPLE OPQRST History
  • Rapid onset, usually 3060 seconds following
    exposure.
  • Speed of reaction is indicative of severity.
  • Previous allergies and reactions.
  • Physical Exam
  • Presence of severe respiratory difficulty is key
    to differentiating anaphylaxis from allergic
    reaction.

110
Assessment Findings in Anaphylaxis
  • Physical Exam
  • Facial or laryngeal edema
  • Abnormal breath sounds
  • Hives and urticaria
  • Hyperactive bowel sounds
  • Vital sign deterioration as the reaction
    progresses

111
Epi-Auto Injector
  • Indications anaphylaxis requires??

112
anaphylaxis
  • Difficulty Breathing
  • Systemic Skin reactions
  • Hypotension

113
Epi-Auto Injector
  • Contraindications

114
Epi-Auto Injector
  • Dosage

115
Epi-Auto Injector
  • Actions

116
Epi-Auto Injector
  • Side Effects

117
Epi-Auto Injector
  • Administration

118
SHOCK is INADEQUATE TISSUE PERFUSION
In a Nutshell..
119
OB / GYN
120
OB / GYN
  • Labor
  • Bloody Show
  • Crowning
  • Predelivery Emergencies

121
Labor
  • Stage One (Dilation)
  • Stage Two (Expulsion)
  • Stage Three (Placental Stage)

122
Management of a Patient in Labor
  • Transport the patient in labor unless delivery is
    imminent.
  • Maternal urge to push or the presence of crowning
    indicates imminent delivery.
  • Delivery at the scene or in the ambulance will be
    necessary.

123
Field Delivery
  • Set up delivery area.
  • Give oxygen to mother and start
  • Drape mother with toweling from OB kit.
  • Monitor fetal heart rate.
  • As head crowns, apply gentle pressure.

Suction the mouth and then the nose. Clamp and
cut the cord. Dry the infant and keep it
warm. Deliver the placenta and save for transport
with the mother.
124
OB / GYN ( Normal Delivery)
125
OB / GYN ( Normal Delivery)
126
OB / GYN ( Normal Delivery)
127
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128
OB / GYN ( Normal Delivery)
129
OB / GYN ( Normal Delivery)
130
OB / GYN ( Normal Delivery)
131
Apgar Scoring
132
OB / GYN ( Normal Delivery)
  • Care of Newborn

133
OB / GYN (Resuscitation)
  • HR Less than 100

134
OB / GYN (Resuscitation)
  • HR less than 80

135
OB / GYN (Resuscitation)
  • HR less than 60

136
Neonatal Resuscitation
  • If the infants respirations are below 30 per
    minute and tactile stimulation does not increase
    rate to normal range, assist ventilations using
    bag valve mask with high-flow oxygen.
  • If the heart rate is below 80 and does not
    respond to ventilations, initiate chest
    compressions.
  • Transport to a facility with neonatal intensive
    care capabilities.

137
Causes of Bleeding During Pregnancy
  • Abortion
  • Ectopic pregnancy
  • Placenta previa
  • Abruptio placentae

138
Ectopic Pregnancy
  • Assume that any female of childbearing age with
    lower abdominal pain is experiencing an ectopic
    pregnancy.
  • Ectopic pregnancy is life-threatening. Transport
    the patient immediately.

139
Placenta Previa
  • Usually presents with painless bleeding.
  • Never attempt vaginal exam.
  • Treat for shock.
  • Transport immediately treatment is delivery by
    c-section.

140
Abruptio Placentae
  • Signs and symptoms vary.
  • Classified as partial, severe, or complete.
  • Life-threatening.
  • Treat for shock, fluid resuscitation.
  • Transport left lateral recumbent position.

141
Abnormal Delivery Situations
142
OB / GYN (Abnormal Deliveries)
  • Breech

143
Breech Presentation
  • The buttocks or both feet present first.
  • If the infant starts to breath with its face
    pressed against the vaginal wall, form a V and
    push the vaginal wall away from infants face.
    Continue during transport.

144
OB / GYN (Abnormal Deliveries)
  • Prolapsed Cord

145
Prolapsed Cord
  • The umbilical cord precedes the fetal presenting
    part.
  • Elevate the hips, administer oxygen, and keep
    warm.
  • If the umbilical cord is seen in the vagina,
    insert two gloved fingers to raise the fetus off
    the cord. Do not push cord back.
  • Wrap cord in sterile moist towel.
  • Transport immediately do not attempt delivery.

146
OB / GYN (Abnormal Deliveries)
  • Limb Presentation

147
Limb Presentation With limb presentation, place
the mother in kneechest position, administer
oxygen, and transport immediately. Do not
attempt delivery.
148
Other Abnormal Presentations
  • Whenever an abnormal presentation or position of
    the fetus makes normal delivery impossible,
    reassure the mother.
  • Administer oxygen.
  • Transport immediately.
  • Do not attempt field delivery in these
    circumstances.

149
Other Delivery Complications
150
OB / GYN (Abnormal Deliveries)
  • Multiple Births

151
Multiple Births
  • Follow normal guidelines, but have additional
    personnel and equipment.
  • In twin births, labor starts earlier and babies
    are smaller.
  • Prevent hypothermia.

152
OB / GYN (Abnormal Deliveries)
  • Meconium

153
Meconium Staining
  • Fetus passes feces into the amniotic fluid.
  • If meconium is thick, suction the hypopharynx and
    trachea using an endotracheal tube until all
    meconium has been cleared from the airway.
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