Professional Documents
Culture Documents
WELCOME!
!!Flight Paramedic !!Critical Care Training at University of Maryland Shock Trauma and Johns Hopkins !!Lead Instructor UF CCP Program !!10 years of EMT/ Paramedic Instruction
PATIENT ASSESSMENT
MEDICAL EMERGENCIES
AIRWAY CONTROL
PEDIATRIC PATIENTS
BACKBOARDING
YOU NEED
!!J ones and Bartlett Emergency Medical Responder Book !!P DF of slides posted in Facebook site
BE THIS GUY/GIRL
!!H ave it with you everyday in class !!I f you dont use it, you lose it !!p ractice makes perfectpractice a LOT!
SPHYGMOMANOMETER
!!A KABP Cuff !!M ust be manual !!N O AUTOMATICS
OPTIONAL
!!t rauma shears !!p en light
CLICKER QUESTIONS
!!y ou will be assigned one next class !!q uestions each class !!B RING TO EVERY CLASS! !!i f you lose it, you owe me $50 !!Wont get certificate until you turn it in
GRADES
!!m id term !!f inal exam !!c licker questions !!p ractical skills station !!n eed an 80% to pass plus pass both skill stations
QUESTIONS?
OK
EMS SYSTEMS
!!First Responder !!EMR !!EMT (Emergency Medical Technician) !!Paramedic !!RN (Registered Nurse) !!PA, ARNP !!Physician !!Allied Health (RT, Techs)
DISPATCH
!!m akes sure the appropriate equipment and personnel are dispatched to the scene !!m ay use pagers, cell phones, radio, or computers
FIRST RESPONSE
!!f irefighters or law enforcement !!M ost firefighters are at least EMT, many are Paramedics !!L EO are first responder/CPR trained
EMS RESPONSE
!!B LS: EMT and EMT/ EMR/FR !!A LS: Paramedic and Paramedic/EMT !!B LS: Basic Life Support !!A LS: Advanced Life Support
EMS RESPONSE
!!E MR can do any skill an EMT can do. !!E MT IS the HIGHER certification !!A irway control !!Treat bleeding/ shock !!A ssist with medications
HOSPITAL CARE
!!E mergency Department works closely with EMS !!S pecialized facilities: !!Trauma Centers !!S troke Centers !!B urn Units !!P ediatrics/Neonatal
MEDICAL CONTROL
!!E MS Clinicians work under protocols !!O verseen by physician !!M ay deviate with permission !!D r. David Meurer
TRANSPORT
!!A mbulance, Medic, Rescue, Truck, Bus !!U se of Lights and Sirens !!R apid Transport/ Load and Go
DOCUMENTATION
!!C : Chief Complaint !!H : History (Past medical history and history of events) !!A : Assessment !!R (x): Treatment !!T: Transport
DOCUMENTATION
!!N ever Lie, make stuff up! !!W rite every report like you will go to court !!U se correct grammar !!D ont use abbreviations in final written report !!I f you dont document it, you didnt do it!
STRESS IN EMS
!!l ong hours !!h igh pressure situations !!w ork holidays/ weekends !!e xtended time away from family and freinds !!h igh divorce rate !!d ifficult to have normal relationships !!b ad calls/patients !!p ediatrics !!b ad trauma !!d eath
STRESS IN EMS
!! dealing with stress essential to avoid burnout !! EtOH and tobacco not a solution! !! Find your happy place and positive outlet !! Use CISD! !! Sense of humor is a coping mechanism dont take offense to it! !! Get sleep and exercise! !! Healthy Diet
STRESS MANAGEMENT
!! Recognizing stress
!! Warning signs to help you recognize stress:
!!Irritability !!Inability to concentrate !!Change in normal disposition !!Difficulty in sleeping or nightmares !!Anxiety !!Indecisiveness !!Guilt
STRESS MANAGEMENT
!! Recognizing stress (cont d)
!! Warning signs: (cont d) !! Loss of appetite !! Loss of interest in sexual relations !! Loss of interest in work !! Isolation !! Feelings of hopelessness !! Alcohol or drug misuse or abuse !! Physical symptoms
INFECTIOUS DISEASE
!!B SI: Body Substance Isolation !!Fungus, Bacteria, Prions, Viruses !!U se gloves, sleeves, eye glasses, surgical masks, HEPA mask
HIV
!!Spread through blood, semen, or vaginal secretions !!Wear gloves !!People with HIV look normal, cannot tell by looking at them !!Usually contract secondary opportunistic disease (Hepatitis, TB)
HEPATITIS
!!A, B, C, D, E !!Hep B&D covered by vaccine !!Hep B more contagious and lethal than HIV !!Hep C most commonly acquired infectious disease amongst HealthCare workers !! Jaundice: results from bilirubin in blood
TUBERCULOSIS (TB)
!!A irborne !!H EPA mask required !!P PD: TD Skin test, can show if youve been exposed !!c oughing, hemoptysis, night sweats, weight loss !!C XR
INFLUENZA
!!A irborne !!C an lead to opportunistic infections !!F or the love of GOD get the flu shot every year!
MRSA
!! Methicillin-Resistant Staphylococcus Aureus !! Gram positive !! Direct contact: mucous, body fluids !! Very common in hospitals/nursing homes !! Can lead to severe sepsis !! 25% population is positive in nasal passage
VRE
!!Vancomycin-Resistant Enterococci !!Can develop in septic patients who become resistant to antibiotics !!Hard to treat !!High mortality !!Use extreme precautions
C-DIFF
!!C lostridium difficile !!g ram +, spore forming rod !!O pportunistic infection !!C an survive standard cleaning measures !!P asses along in hospitals
C-DIFF
!!S evere diarrhea !!o ften comes back after antibiotic treatment !!m egacolon: surgical emergency !!f ecal transplant
PRIONS
!!C reutzfeldt-Jakob !!K uru !!C an survive the autoclave process
BSI
!!WASH YOUR DAMN HANDS! !!T he little EtOH dispensers are NOT enough! !!P rotects you and your patients
!! Response
!! Fasten your seatbelt, plan the best route, and drive quickly but safely to the scene. !! Technically, you can only go 10 mph over the speed limit while using lights and sirens. !! ALWAYS obey speed limits in school zones !! Motorists should pull over to the right, or the safest place to allow ambulance to pass
!!Electrical hazards
!! Do not approach the scene and keep other people away from the source of the hazard.
!! If you are not, do not exceed the limits of your training. !! Never enter a burning building without proper turnout gear and SCBA.
Mark Winfrey/ShutterStock, Inc.
!! Hazardous materials
!! Unstable objects
!! Vehicles, trees, poles, buildings, cliffs, and piles of material
!! Sharp objects
!! Broken glass at the scene of a motor vehicle crash
!! Animals
!! Can be pets, farm stock, or wild !! Should be secured in a room away from the patient !! May present other hazards such as bites, kicking, or even trampling
MEDICAL LEGAL
!! Laws differ from one location to another, so EMRs should learn the specific laws that apply in their state or jurisdiction. !! Do not lose sight of these concepts:
!! Above all else, do no harm. !! Provide all your care in good faith. !! Provide proper consistent care, be compassionate, and maintain your composure.
DUT Y TO ACT
!! If you are employed by an agency as an EMR and you are dispatched to the scene of an accident or illness, you have a duty to act.
!! You must proceed promptly to the scene and render emergency medical care within the limits of your training and available equipment.
DUT Y TO ACT
!! Failure to respond or render care leaves you and your agency vulnerable to legal action.
Credit: Corbis
STANDARD OF CARE
!! The standard of care is the manner in which you must act or behave. !! You must meet two criteria:
!! You must treat the patient to the best of your ability. !! You must provide care that a reasonable, prudent person with similar training would provide under similar circumstances.
SCOPE OF CARE
!! Scope of care is defined by:
!! The US Department of Transportation, Emergency Medical Responder Educational Standards !! Medical protocols or standing orders !! Online medical direction
!! Emergency treatment must wait until a patient or legal guardian consents to the treatment. !! If permission cannot be quickly obtained, do not hesitate to give appropriate medical care.
ADVANCE DIRECTIVES
!! An advance directive is a document that specifies what a person would like to be done if he or she becomes unable to make his or her own medical decisions. !! A living will
!! Written document drawn up by a patient, a physician, and a lawyer !! States the types of medical care the person wants or wants withheld
ADVANCE DIRECTIVES
!! A durable power of attorney for health care
!! Allows a patient to designate another person to make decisions about medical care
ADVANCE DIRECTIVES
!!I f you are unable to determine if an advance directive is legally valid, begin appropriate medical care.
!!Some states have systems in place, such as bracelets, to identify patients with advance directives.
ABANDONMENT
!! Abandonment occurs when a trained person begins emergency care and then leaves the patient before another trained person takes over. !! Once you have started treatment, you must continue it until a person who has at least as much training arrives and takes over.
NEGLIGENCE
!! Negligence occurs when a patient sustains further injury or harm because the care administered did not meet standards. !! These conditions must be present:
!! Duty to act !! Breach of duty !! Resulting injuries !! Proximate cause
CONFIDENTIALIT Y
!! Most patient information is confidential.
!! Patient circumstances !! Patient history !! Assessment findings !! Patient care given
!! Information should be shared only with other medical personnel. !! In certain circumstances, you may release confidential information to designated individuals. !! Health Insurance Portability and Accountability Act of 1996 (HIPAA)
!! Strengthens laws for the protection of the privacy of health care information and safeguards patient confidentiality
REGULATIONS
!! Become familiar with the federal, state, local, and agency regulations that affect your job. !! Certification or registration may be required to work as an EMR. !! You are responsible for keeping certifications or registrations current.
REPORTABLE EVENTS
!! Reportable crimes include:
!! Knife wounds !! Gunshot wounds !! Motor vehicle collisions !! Suspected child or elder abuse !! Domestic violence !! Dog bites !! Rape
VITAL SIGNS
!!B lood Pressure !!H eart Rate !!R espiratory Rate !!P upils !!S kin condition
BLOOD PRESSURE
!!S ystolic pressure: high reading during contraction (systole) !!D iastolic pressure: low reading during relaxation (diastole) !!N ormal is patient dependent (not necessarily 120/80)
BLOOD PRESSURE
!!P ump up to around 200 mm Hg or until the beating is no longer auscultated !!T he first beat is the systolic pressure !!T he last beat heard is the diastolic pressure !!P alpating: !!U se cuff and feel for a radial pulse !!P ump up until the pulse is gone !!R elease until pulse returns and that is systolic !!W rite: 120/P
HEART RATE
!!Adult: 60-90 !!>100 tachycardia !!<60 bradycardia !!Child:70-120 !!Infant: 80-130 !!Major: carotid, radial, brachial, femoral, pedal !!Count for 15 s and multiply by 4
RESPIRATORY RATE
!!D O NOT tell patient youre watching them breathe !!C ount for 30 s and multiply by 2 !!N ormal rate: 6-20 bpm !!> 20/min is tachypnea
RESPIRATORY
!!K ussmals: DKA !!C heyne-Stokes: CVA !!B iots: Head injury !!A gonal: Dead
PUPILS
!!1 -10 mm !!N ormal depends on light conditions !!C onstricted: sympathetic !!D ilated: parasympathetic !!I psilateral pupil dilation: herniation
SKIN
!!C olor: pink, pale, cyanotic (blue/ purple), flushed (red) !!Temperature: warm, cool, hot !!C ondition: dry, diaphoretic !!Turgor: tenting
QUESTIONS?