EMS 150 Lesson A Boone County Fire Protec/on District EMS Educa/on - - PowerPoint PPT Presentation

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EMS 150 Lesson A Boone County Fire Protec/on District EMS Educa/on - - PowerPoint PPT Presentation

May 28, 2023 236 likes •473 views

EMS 150 Lesson A Boone County Fire Protec/on District EMS Educa/on Course Overview Assessment Flowchart Assessment Inventory Underlying Theme Circulation (Shock / Types of Shock) Ventilation Oxygenation Boone

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Boone County Fire Protec/on District EMS Educa/on

EMS 150 Lesson A

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Course Overview

  • Assessment Flowchart
  • Assessment Inventory
  • Underlying Theme
  • Circulation (Shock / Types of Shock)
  • Ventilation
  • Oxygenation
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Lesson A Overview

  • Assessment Skills
  • Emergent / Immediate Interventions
  • Circulation-Ventilation-Oxygenation
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Flowchart

  • Is this a “code” (cardiac arrest)?
  • CVO assessment
  • Immediate interventions?
  • Focused H&P to drive a differential Dx list
  • Ddx drives specific interventions / plan of care
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Inventory

  • All of the things you MUST consider
  • Determine WHICH you will do / utilize
  • Few patients need ALL of these things
  • Prioritize / delegate
  • Gather data / toss out noise / get information
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CVO

  • Major Body Processes
  • Must Circulate blood
  • Must Ventilate air for gas exchange
  • Must Oxygenate the blood to be circulated
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Circulation

  • Shock defined
  • Obstructive Shock defined
  • Hypovolemic Shock defined
  • Cardiogenic Shock defined
  • Distributive Shock defined
  • Assessment options (pulses, skin, HR, BP)
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Ventilation

  • Rate of breathing
  • Effort / work of breathing
  • Depth of breathing (“dead spacing”)
  • EtCO2 as a tool
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Oxygenation

  • Adequate O2 content inspired
  • Intact process in alveoli for gas exchange
  • Assessment challenges (SpO2 limitations)
  • Lung Sounds assessment
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Lab A

  • Pulse oximetry
  • Capnography
  • ECG limb leads
  • BP via auscultation, palpation, doppler, use of

machine pressures

  • Lung Sounds auscultation
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More for Lab A

  • Two-thumbs down / BVM ventilation
  • Oxygen Therapy
  • PEEP via BVM, CPAP, BiPap
  • Nebulizer treatments
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Pulse Oximetry

  • Not real time—may be 1-2 minutes old
  • Signal strength is key to check before you start

believing the number (match to pulse)

  • Requires adequate perfusion—patient with

SpO2 of 60 and BP of 60 example

  • Can be fooled by Carbon Monoxide (CO)
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Capnography

  • Real time—no delay
  • Requires adequate metabolism to make CO2

at the cells

  • Requires adequate circulation to bring back

CO2 to the lungs

  • If those two are intact, shows you ventilation

data—number and waveform shape matters

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HR and Breathing

  • Radial pulse palpation is a great 1st step
  • Touch is good (let’s you feel skin)
  • Look at the patient’s breathing rate, effort

and depth while holding their pulse

  • Presence lets you estimate BP
  • Rate and Regularity gives you data on Heart
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Blood Pressure

  • Size and place the cuff
  • Auscultate when you can hear
  • Palpate when you cannot hear but can feel a

pulse

  • Doppler when you cannot hear or feel a pulse
  • Machines don’t forget to take it or what it was
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Two-Thumbs Down

  • Big muscles of your hands make the seal
  • Jaw thrust at the same time
  • Very important
  • Takes skill—more than squeezing a bag!
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BVM Ventilation

  • Do NOT use too much volume—hurts BP
  • DO get normal chest rise
  • Adult BVM holds 1500 cc!!!!!
  • Looking for tidal volume of 300-500 for most

adults—taller needs more

  • ONLY use two hands when you need more

pressure (think about why)—not volume

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Oxygen Therapy

  • “Normal” varies if patient has lung disease
  • Target is 94-99% for those without lung

disease

  • Adjust your target downward for lung disease
  • 90-95% may be their norm
  • 5% below “normal”
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O2 Tools

  • Nasal cannula at 2-3 liters per minute for 2-3

minutes should raise the SpO2 by 2-3 points.

  • If you need more than 2-3 points, use the

NRBM.

  • If the SpO2 is not rising toward “normal” with

cannula as above, consider why…may be a ventilation problem??

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PEEP

  • Recruits all available alveoli into the game
  • Reduces work of breathing—prevents

atelectasis

  • Conscious patients may not like the tight-

fitting mask at first

  • Raises intra-thoracic pressure which may

reduce preload (reduce BP)

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CPAP or BiPAP

  • Continuous Positive Airway Pressure
  • Bi-level Positive Airway Pressure
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Nebulizer Tx

  • Makes tiny droplets out of the medication
  • Patient can hold or can be attached to a mask
  • Can use with CPAP / BiPAP mask usually
  • Beware of dead-spacing