ems equipment review march 2015 ce condell medical center ems system ce idph site code #107200e-1215...
TRANSCRIPT
EMS Equipment Review
MARCH 2015 CECONDELL MEDICAL CENTER EMS SYSTEM CEIDPH SITE CODE #107200E-1215
PREPARED BY: SHARON HOPKINS, RN, BSN, EMT-P
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Objectives
Upon successful completion of this module, the EMS provider will be able to:List indications for use of a variety of EMS equipment used in the field.Manage a group of peers in setting up and applying a variety of equipment used in the field.Evaluate the effectiveness of application of a variety of EMS equipment in a practical setting.
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Objectives cont’d
Actively participate in review of selected Region X SOP’s as related to the topics presented.
Actively participate in review of the process of transmission of 12 lead EKG’s using department specific equipment.
Actively participate in reviewing the operation of your department monitor/defibrillator, pacing capacity, synchronized cardioversion
and defibrillation at the paramedic level.
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Objectives cont’d
Actively participate in HARE/Saeger traction application.
Successfully complete the post quiz with a score of 80% or better.
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Equipment and Patient Interventions
There comes responsibility when using equipment in the delivery of patient care. You need to: recognize what the problem is to know what to do be able to distinguish what the appropriate
intervention(s) is/are understand how to properly apply and use the equipment
chosen recognize when the intervention is working as well as not
accomplishing the goal know what documentation must be done with each piece
of equipment used in patient care be knowledgeable regarding the cleaning and returning
to service for each piece of equipment
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Capnography Background
A continuous, non-invasive monitoring tool Measures level of CO2 at end of exhalation
Quantitative results provides a number
Assesses respiratory status thru-out respiratory cycle Provides current, at the moment, breath-to-breath
information on patient status Results measured as mmHg of CO2
Normal 35 – 45 mmHg
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Capnography Information
Numeric value provides end tidal (end of breath) CO2 level
Waveform is a picture representation of the CO2 value exhaled with each breath
Airway status reflected in: ETCO2 value (mmHg)
Waveform picture Respiratory rate
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Definitions
Ventilation Process of breathing; eliminating CO2 from body
Respiration Exchange of gasses at alveoli level
Oxygenation Getting O2 to tissues; measured by pulse oximetry
Diffusion Process by which gas moves between alveoli and pulmonary capillaries
(gases move from area of high concentration to areas of low concentrations)
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Capnography Usefulness
Provides information on how effectively the body is: Producing CO2 (metabolism)
Transporting CO2 (perfusion)
Exhaling CO2 (ventilations)
Goal – attain/maintain CO2 levels 35 – 45 mmHg
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Capnography Usefulness cont’d
Confirms and monitors advanced airway placement Indicates effectiveness of chest compressions
Blood must circulate through lungs to off-load CO2 for it to be exhaled
Levels expected to minimally be >10mmHg during CPR
Indicates return of spontaneous circulation (ROSC) Sudden, sustained rise in levels toward 35-45 mmHg
Allows early interventions to be started
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Capnography Usefulness cont’d
Monitor asthma & COPD conditions and response to bronchodilator therapy
Detect increased respiratory depression and hypoventilationTiring accessory musclesNeuromuscular disease effect on respiratory centerChange in level of consciousness – alcohol/drug overdose,
head trauma, sedation/analgesiaSeizure activity &/or post ictal period
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Capnography Waveform
A-B – respiratory baseline B-C expiratory upslope C-D expiratory plateau D – end of exhalation
point of measurement D-E – inspiratory downslope
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Capnography Waveforms
HypoventilationCO2 retained so
values
HyperventilationCO2 eliminated
so values
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Capnography Waveforms
Asthma attack or COPDDifficulty exhaling evidenced by slow, gradual
upslope
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Capnography Waveforms
Apnea or loss of advanced airway
- flat line
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ETCO2 Detector
End tidal (end of breath) CO2 detector
Qualitative device Indicates presence/absence of detectable CO2 exhaled via pH
sensitive paperDoes not provide specific measurement of numeric value
Color scale estimates CO2 levelAble to change as detected levels change
May take up to 6 breaths to wash enough CO2 out for proper measurement
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ETCO2 cont’d
Gastric content or acidic drug contact on pH paper can affect accuracy of values detected
When perfusion decreased (shock, arrest) ETCO2 reflects change in pulmonary blood flow and CO2 level
Does not reflect ventilation status
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Altered CO2 Levels
CO2 level
Shock, cardiac arrest, pulmonary embolism, bronchospasm, complete airway obstruction
CO2 level
Hypoventilation, respiratory depression, hyperthermia
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CO2 Influence on Circulation
CO2 in blood (hypoventilation)Cerebral vasodilation increase in intracranial
pressure (ICP) due to increased blood flow to the brain
CO2 in blood (hyperventilation)Cerebral vasoconstriction decrease in fresh blood
flow to brain; decrease in levels of adequate oxygen and glucose negatively affect function of brain
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ETCO2 Result Interpretation
Yellow – yes, CO2 is being detected in exhaled breath
Tan – poor perfusion or ventilation statusFirst evaluate placement of airway deviceContinue to trouble shoot
Blue or purple – no CO2 being detected
First evaluate placement of airway deviceContinue to trouble shoot
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Trouble Shooting Advanced Airway Placement – “DOPE”
D – displacement of tube (i.e.: into esophagus)Chest rise and fall?Gastric sounds? Bilateral breath sounds?
O – obstruction P – pneumothorax E – equipment failure
Faulty cuff
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Esophageal Detector Device - EDD
A modified bulb syringe Simple means of evaluating for missed endotracheal
intubation Squeeze bulb, attach to end of endotracheal tube Bulb re-expands = tube in trachea Bulb does not re-expand or does so slowly – collapsing
sides of esophagus onto tube preventing air from filling EDD – consider esophageal placement
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EDD cont’d Need to interrupt ventilations to use device Evaluate results of technique used with results of all
other steps of confirmation – could be extenuating reason why you get false negatives
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Defibrillators
Electrical capacitor that stores energy Biphasic defibrillators provide waveforms that
use less DC energy than monophasic machinesEnergy flows in one direction and then reverses
Therefore, possible decrease in tissue damage Survival rates increase if early CPR provided
with prompt defibrillation attempt as soon as possible after collapse
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Defibrillation
Early defibrillation critical to survival from sudden cardiac arrestMost frequent initial rhythm in arrest is VFTreatment for VF is defib (defibrillation)Probability of successful defibrillation diminishes
over timeVF deteriorates to asystole over time
Check with your vendor to know your biphasic device’s recommended energy settings
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Ventricular Fibrillation as Presenting Rhythm
Best chance of survival in public Early activation of EMS CPR initiated very soon after collapse Early application of AED or other defibrillation attempt
Current passes though fibrillating heart to depolarize heart cells to allow them to uniformly repolarizeAllows dominant pacemaker (SA node) to take over
electrical controlGoal – resume organized electrical activity
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Influences on Success of Defibrillation
Time from onset of VF – shorter time survival Condition of myocardium
Less success in presence of hypoxia, acidosis, hypothermia, electrolyte imbalance, drug toxicity
Pad sizeLarger pads felt to be more effective and cause
less myocardial damage; should not overlapIdeal size for adults10-13 cm (4 -5 inches)Ideal size for peds 4.5 cm (roughly 3 inches)
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Influences cont’d
Pad / skin interfaceNeed to the resistance
Greater the resistance the less energy delivered to the heart and the greater the heat production at the skin surface
Pad contactMax contact with skin; no air bubbles breaking
contact; no pads touching or overlapping Avoiding placement of pads over bone
Bone is poor conductor of electricity
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Pad PlacementOperator Choice
Anterior /posterior1 pad over apex of heart, under left
breast1 pad under left scapula in line with
anterior pad Anterior/anterior (apex)
Anterior pad on right upper sternum just below clavicle
Apex pad below left nipple in anterior axillary line over apex of heart
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Pad Placement cont’d
DO NOT place padsOver sternum – bone poor conductor of
electricityOver pacemaker or AICD – deflects energy;
could damage the implanted devicePlace at least one inch away from device
Over topical medication patches – deflects energy
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Defibrillation
IndicationsVF, pulseless VT
ContraindicationsFailure to demonstrate one of the above rhythmsAsystole – defibrillation places a patient into
asystole for the dominant pacemaker to take overPEA – electrical activity not a problem; needs
mechanical response fixed
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Defibrillation
EquipmentMonitor/defibrillatorDefibrillating pads
Example: PadProDefibrillation/pacing/cardioversion/monitoring
electrodes
Most come with conductive gel already applied in center of pad
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Defibrillation Safety
CPR is performed just until the defibrillator is ready Confirm O2 not blowing across patient’s chest wall –
hold away from the patient when not using the BVM Physically look all around (“nose to toes”) Clearly yell out “all clear” Deliver energy
Immediately resume CPR
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Return of Spontaneous Circulation ROSC After 2 minutes of resumed CPR, evaluate the
rhythm If an organized rhythm is viewed on the
monitor, THEN check for a pulse If no pulse, rhythm is PEAResume CPR
Adult 1 and 2 man CPR 30:2Infant and child 1 man CPR 30:2Infant and child 2 man CPR 15:2
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Indications to Activate Cooling Protocol Post ROSC
Presumed cardiac arrestNOT indicated for respiratory or traumatic
arrest Remains unconscious and unresponsive ROSC present at least 5 minutes Systolic B/P >90 with or without pressor agent
use (i.e.: Dopamine) Airway has been secured
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ROSC Contraindications
Major head trauma or traumatic arrest Recent major surgery within past 14 days Systemic infection (i.e.: septic shock) Coma from other causes Active bleeding Isolated respiratory arrest Hypothermia (34o C/93.2o F) already present
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Induction of ROSC
Place ice paks in the axilla, neck and groinAreas where blood vessels tend to be superficial
Place ice pak over IV site If patient begins to shiver, contact Medical
ControlAnticipate order for Valium to stop the shiveringShivering will generate heat and therefore
increase body temperature
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Vasopressor - Dopamine
Stimulates alpha, beta, and dopaminergic receptors based on dose provided
Starting dose 5mcg/kg/min IVPB up to 20 mcg/kg/min
Take patient’s weight and drop last numberMinus 2 from number leftLeft with rate to run IVPB in drops per minuteEx: 150 pounds; drop “0”
15 – 2 = 13 drops per minute
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Dopamine cont’d
Dopaminergic effects at 2 mcg/kg/minRenal vasodilation to improve blood flow to kidneysKeep kidneys working, the body keeps working
Beta effects 5 – 10 mcg/kg/min Increases strength of myocardial contraction – squeeze
more blood out of ventricles Alpha effects at >20 mcg/kg/min
Severe vasoconstriction that diminishes blood flow to all tissues
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AED (Automated External Defibrillator) Function
AED’s will Analyze rhythms Deliver a shock if indicated
Ventricular fibrillation (VF)Monomorphic and polymorphic VT if rate and R
wave morphology exceed preset values
Will not deliver a synchronized shock Can indicate loose electrodes / poor electrode
contact
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AED Use in Pediatrics
Pediatric attenuator used to deliver lower energy doses to children (built into cables with peds pads)
1-8 year old Use pediatric pads if available No attenuator (peds pads)available, use standard AED pads
< 1 year old Manual defibrillator preferred If no manual defibrillator, use peds pads with attenuator No peds pads, use AED pads available
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AED Use With CPR
Do NOT interrupt CPR to apply padsApply pads while CPR in progress
Do not touch patient during analysis phase Can provide compressions during charging phase No O2 flow across patient body during defibrillation
attempt Call and look “ALL CLEAR” prior to each defibrillation
attempt Immediately resume CPR
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Transition From AED To DefibrillatorUpon arrival at scene, if AED ready to discharge, utilize
AEDDo not interrupt operation of device
During 2 minutes of CPR, can switch from AED use to monitor/defibrillator
Immediately resume CPR after delivery of each defibrillation attempt regardless of equipment used
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Synchronized Cardioversion
A controlled form of defibrillation using a lower energy level that interrupts underlying reentrant pathway
Used with organized rhythms and in presence of a pulse Monitor interprets QRS cycle and energy delivered
during R waveLess vulnerable area of QRSDownslope of T wave is relative refractory area
Minimal stimulant could generate rhythm into VF
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Indications Synchronized Cardioversion
Unstable tachyarrhythmiasSVTRapid atrial fibrillation or flutter
Hazard of breaking loose a blood clot in the atria and resulting in a stroke
Ventricular tachycardia
Note: polymorphic VT NOT likely to respond to synchronized cardioversion – no defined R wave
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Synchronized Cardioversion Procedure
Apply padsAnterior/anterior or anterior/posterior position
Sedate if possibleThis is a painful procedure!Versed 2 mg IVP/IO; repeated every 2 minutes;
max 10 mg (desired effect – sedation!) Consider pain management
Fentanyl 1 mcg/kg IVP/IN/IO; may repeat in 5 minutes to max of 200 mcg total dose
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Sync Procedure cont’d
Activate “sync” buttonVerify R wave is being flagged/identified
Choose energy setting starting at the lowest watt setting100j, 200j, 300j, 360j
Verify O2 not blowing across chest wall
Look (nose to toes) and call “ALL CLEAR” Press and hold sync buttons until energy discharged
Momentary delay waiting to identify the R wave
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Sync Procedure cont’d
If synchronized cardioversion needs to be repeated, need to reset the “sync” buttonSafety that machine will default to defibrillation mode after
every discharge of energy
If VF occurs, verify sync mode is off and defibrillate patient without delay
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Transcutaneous Pacemaker - TCP
Electrical cardiac pacing across the skin TCP is a painful non-invasive procedure so sedation
will most likely be necessary Indications
Symptomatic bradycardiaHypotensiveHypoperfusing
Evaluate level of consciousness and B/P for most reliable indicators of patient condition/stability
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TCP Procedure
Apply pads (-) over apex of heart, anterior chest wall (+) mid upper back below left scapula
Set desired heart rate (80) Confirm sensitivity at auto/demand Begin mA current at 0 Turn pacer on
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TCP Procedure cont’d Slowly increase output until ventricular capture
Spike followed by widened QRS Reassess vital signs and pain level Document settings – mA and rate Reassess need for sedation and analgesia
Valium 2 mg IVP/IO over 2 minutes; repeat every 2 minutes until max of 10 mg total dose
Fentanyl 1 mcg/kg IVP/IO/IN ; can repeat dose in 5 minutes with max total of 200 mcg
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Critical Thinking Skill and TCP
In setting of acute MI, consider contacting Medical ControlMay want to decrease heart rate of TCP just
enough to maintain perfusion Want to avoid increasing the work load on the
heart by automatically selecting 80 as the heart rate Increasing work load on heart may increase the
size of the infarction
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What would you do…
You applied the TCP for a symptomatic bradycardia You had a paced rhythm You notice the following rhythm strip change – what is the
rhythm and what would you do?
Reassess patient; increase mA; consider need for CPR
Failure to capture
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Defibrillation During Pacing Mode
Check your device for specifics When in the pacing mode and the need to
defibrillate occurs, for some models, you may have to turn off the pacing mode
If pacing must be resumed, reset all levels
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12 Lead EKG’s
A graphic recording of electrical activity in the heart Must evaluate the pulse to determine mechanical
response Single lead (i.e.: lead II) evaluates cardiac rhythms 12 lead views can diagnose an acute MI Early interpretation of 12 lead EKG early
diagnosing early reperfusion & restoring blood flow to ischemic tissues
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Acute MI
Death of portion of heart muscle from prolonged deprivation of oxygenated blood
Heart’s demand exceeds supply of oxygen over extended period of time
Often associated with atherosclerosis process Location and size of infarct depends on vessel
involved and site of obstructionLeft ventricle most common site
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Evolution of Acute MI
Ischemia – initial lack of oxygenST depression can be reversible
Injury to myocardial tissueST elevation can be reversible
Death/infarctionNecrotic tissue can lead to scar formation Irreversible processCan leave a positive Q wave marker in leads affected
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AMI Process
Ring of ischemic tissue surrounds infarcted myocardium
Collateral circulation may develop Ischemic area often site of arrhythmia
development
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Complications of AMI
Arrhythmia most common VF most lethalMost common cause of sudden death within one hour
of onset of signs and symptoms Destruction of myocardial muscle mass can lead to
CHF due to impairment of pumping capability Cardiogenic shock may develop if heart function is
inefficient and inadequate Ventricular aneurysm can develop due to damaged
wall of heart – can rupture causing instant death
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Patient Assessment
Pain most common chief complaintLasts more than 30 minutesNot relieved by rest or NTG
Tired and weak most often complaint in elderly, long standing diabetic and women
Determine responses to OPQRST assessmentActivity at onset, provocation/palliation
(worsens/improves), quality in their words, radiation, severity on 0 -10 scale, time of onset
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EMS Action
Apply monitor Examine underlying rhythm – document
rhythm Obtain 12 lead EKG
Evaluate for ST segment elevationIf elevation, in what group of leads?If depressed, look for reciprocal elevation
Watch for development of arrhythmias
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Proper Placement EKG Chest Leads
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Groups of Acute MI by Leads64
Identifying Groups of ST Elevation 65
Why Aspirin???
Inhibits platelets from aggregating/collecting at site of plaque rupture inside vessel wall
Decreases morbidity and mortality rate Chewed to increase breakdown and absorption time of
medication Patients on daily aspirin already have elevated and
acceptable blood levels of aspirin – don’t have to supplement a dose if absolutely sure they took one today
Always better to give full dose than to risk skipping any dose (just in case of skipped dose)
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12 Lead EKG Procedure
Obtain rhythm strip Interpret, report and document rhythm Obtain 12 lead EKG
Identified with patient age, sex, department name in preparation for transmission
Review for ST elevation pattern Report to Medical Control what you see, then
read word for word interpretation on 12 lead EKG printout
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12 Lead EKG Documentation
Interpret the rhythm strip and document on patient care run report
Document presence or absence of ST elevation If elevation, report and document in which
leads Provide copy of rhythm strip and 12 lead EKG
to ED secretary for placement on patient’s medical record
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CPAP
Continuous positive airway pressure Effective therapy for acute CHF –
pulmonary edema Can avert the need for intubation and mechanical
ventilation if applied early enough Maintains constant pressure within the airway
and through-out the respiratory cycle Keeps alveoli open and expanded Increases surface space for diffusion of gases
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CPAP cont’d
Buys time for other therapies (i.e.: medications) to work
PrecautionToo much pressure can
inhibit ventricular filling decreasing cardiac output
B/P can drop
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CPAP Indications
Stable pulmonary edemaAlert; systolic B/P >90mmHg
COPD with wheezingFirst contact Medical Control for orders
For unstable pulmonary edema (altered mental status, systolic B/P <90 mmHg), contact Medical Control to discuss use of CPAP
Reminder: all therapies used in pulmonary edema have potential to drop the B/P
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CPAP Contraindications
Respiratory arrest or apnea Pneumothorax or trauma to chest wall Tracheostomy present
Can’t get tight fit over trach stoma Actively vomiting
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CPAP Procedure
Sit patient upright Assess and obtain baseline vital signs Begin O2 via non-rebreather mask while
setting up equipment Administer first dose NTG
Used as venodilator to decrease blood return to heart (decreases pre-load)
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CPAP Flow Safe II Procedure
Assemble CPAP Flow Safe IIAttach proximal end of O2 tubing with
manometer to port in mask
Attach distal end of tubing to O2 source
Secure face mask snugly to patient’s face using head harness
Adjust O2 flow – 13-14 lpm for 10 cm H2O
Continue administration of medications
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CPAP Procedure cont’d
Lasix 40 mg IVP (80mg if on med at home) as a diuretic If systolic B/P remains >90 mmHg
Morphine 2 mg IVP slowly over 2 minutesMay repeat 2 mg every 2 minutes as needed to max of 10 mgUsed to decrease anxiety and for benefit of vasodilation
If patient shows deterioration during CPAP treatment, remove CPAP, consider intubation, inform Medical Control
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CPAP Tidbits Be prepared to coach patient through first few
minutes of CPAP use until positive effects beginPatient is already frightened Patient may feel suffocated with the mask onExhaling against the resistance is tough at first
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HARE and Saeger Traction
Indicated for isolated mid-femur fracturesReduces muscle spasm and therefore pain levelReduces risk of bones overriding
ContraindicationsOpen fracture
Do not want to draw contamination into the wound
Hip, knee, or pelvic fracturesIncreased risk of nervous or vascular complications
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Preparing for Traction Application
Assess motor/sensory/circulation before and after splintingCan you move this/can you feel that?Mark pulses once found – easier to find the site
on reassessmentCompare to uninjured side
Apply manual traction until mechanical traction in place
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HARE Application
Measure and adjust splint Support distal end of splint on backboard Apply distal ankle hitch while maintaining
manual traction Position traction under injured extremity Secure proximal end to groin area Apply hook to ankle hitch Replace manual traction with mechanical traction
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HARE Traction Adjust straps avoiding over the knee and over the injured
site
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Saeger Traction Application
Support leg and maintain gentle traction Use uninjured leg to measure and adjust splint
length Place splint inside injure leg; padded bar snug
against pelvis in groin (watch pressure areas!!!) Attach strap to thigh Attach padded hitch to foot and ankle Extend splint until correct tension obtained Apply elastic straps to secure leg to splint
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Saeger Splint
Do not place straps over fracture site
Release manual traction
Reassess distal pulse, motor, and sensory
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Pain Control With Use of Traction
Fentanyl 1 mcg/kg IVP/IN/IOMay repeat same dose in 5 minutesMax total dose of 200 mcg
As a CNS depressant, watch the respiratory status If respiratory depression occurs, begin to support
ventilations via BVM1 Breath every 5 – 6 seconds Document 10 -12 breaths per minute assisted
Narcan 2 mg IVP/IN/IO can be used to reverse respiratory depression due to opioid use
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Cleaning of Traction Splints
Rinse off gross contaminant Wet down all surfaces with Cavicide wipes Let device air dry Confirm all straps are accounted for and
repackage device in preparation for next patient
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Combat Application Tourniquet - CAT Indications
Uncontrollable hemorrhage when usual means have failed
ContraindicationsNon-compressable site
EquipmentTourniquet with attached rod
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CAT - Procedure
Apply tourniquet proximal to bleeding site as distal as possible; preferably over bare skin
Pull band very tight and securely fasten band back on itself
Twist rod until bright red bleeding has stoppedOr until distal pulses are eliminated
Place rod inside clip; locking into place Secure straps over clip holding rod
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CAT – Potential Problems
Inability to control bleedingContinue with direct pressurePrepare to apply a second CATApply QuikClot dressing if available
Must be applied directly over wound site for impregnated material to be effective
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CAT – Documentation Pearls
Reason CAT was applied Time and site of CAT application Results post intervention Consideration of administration of pain
medicationFentanyl 1 mcg/kg IVP/IN/IO
May repeat in 5 minutes, same doseMax 200 mcg total dosing
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Midazolam - Versed
Potent, rapid onset, short acting benzodiazepineOnset 3-5 minutesDuration 20-30 minutes
Used as sedative and hypnotic Has amnesic properties and reduces anxiety
Amnesia of recent past (antegrade) useful to inhibit unpleasant reminders of procedures
Low toxicity and high rate of effectiveness
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Indications for Versed Per Region X SOP’s
Sedation prior to synchronized cardioversion Useful to maintain sedation post drug assisted
intubation procedure Suppresses seizure activity
IN route allows safer delivery method Decreases severe anxiety and apprehension
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Precautions With Versed
Crosses placental barrier – could cause respiratory depression in newly born infant
Elderly more sensitive to effects; metabolize med more slowly
Toxicity increases when mixed with CNS depressants (alcohol, opioids like Fentanyl, tricyclic antidepressants)
Toxicity may be higher in patients with COPD
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Side Effects of Versed
Respiratory depression Drowsiness Hypotension
When administering, have a BVM readily available Be prepared to assist respirations
1 breath every 5 – 6 secondsDocument 10 – 12 breaths per minute assisted
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Fentanyl
Synthetic opiate analgesic for pain control Shorter acting than morphine Onset immediate when administered IVP Peak effect 3 5 minutes Lasts 30 – 60 minutes Does not affect blood pressure like Morphine
does
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Dosing For Fentanyl per Region X SOP’s
Adult1 mcg/kg IN/IVP/IOMay repeat same dose in 5 minutesMax total dose 200 mcg
Pediatrics0.5 mcg/kg IVP/IN/IOMay repeat same dose in 5 minutesMax total dose 200 mcg
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Precautions With Fentanyl
Crosses the placental barrier – could cause respiratory depression in newly born infant
Monitor respiratory rate, SpO2 levels, and level of consciousness
Have BVM available to counteract potential respiratory depression1 breath every 5 – 6 secondsDocument 10 – 12 respirations per minute
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Cleaning of Equipment – After Every Patient Use In general, each piece of equipment in contact with a patient
MUST be cleaned between each patient use Gross contaminant must be removed Surfaces need to remain wet and allowed to air dry All cables need to be wiped down (i.e.: EKG, B/P, pulse ox)
Cables drag across contaminated surfaces A LOT!!! B/P cuffs need to be wiped down Pulse ox sensors need to be cleaned following manufacturer
recommendations
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Department Review of Equipment
Review set up of capnography monitoring Review operation of monitor/defibrillator for
defibrillation, synchronized cardioversion, and TCP
Review procedures for transmission of 12 lead EKG to receiving hospital
In teams, apply the HARE or Saeger traction device to a peer
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Bibliography
Bledsoe, B., Porter, R., Cherry, R. Paramedic Care Principles & Practices, 4th edition. Brady. 2013.
Campbell, J., International Trauma Life Support for Emergency Care Providers. 7th Edition. Pearson. 2012.
McDonald, J. ALS Skills Review. AAOS. Jones and Bartlett. 2009.
Mistovich, J., Karren, K. Prehospital Emergency Care 9th Edition. Brady. 2010.
Pediatric Education for Prehospital Professionals 3rd Edition. American Academy of Pediatrics. 2014.
Region X SOP’s; IDPH Approved January 6, 2012. www.MARescue.com
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