EMR Refresher Module I Airway/

EMR Refresher Module I Airway/

EMR Refresher Module I Airway/Cardiac /Neuro/Trauma VENTILATION/ OXYGENATION/CARDIAC/NEUROLO GICAL EMERGENCIES/CNS INJURIES Module I-Section 1-Ventilation & Oxygenation Objectives Discuss some A & P of the airway system Discuss and describe the ventilatory process Alveolar ventilation Minute ventilation

Identify adequate vs. inadequate breathing Difference between respiratory distress and failure Differentiate between the features and indications of oxygen therapy devices including nasal cannula and non-rebreather mask Describe ventilatory assist and measurement of adequacy (introduce ETCO2) When to oxygenate and when to ventilate Describe rescue breathing technique for adults, children and infants Describe the indications for oxygen Describe safety considerations and hazards of oxygen administration A & P of the Airway System Oropharynx Nasopharynx

Pharynx Trachea Esophagus Bronchi Lungs Alveoli Capillaries The Ventilatory Process Alveolar ventilation the exchange of oxygen and carbon dioxide that occurs in the alveoli Minute ventilation the amount of air pulled into the lungs and removed from the

lungs in one minute Adequate vs. Inadequate Breathing Look, Listen, and Feel! Looking for rise and fall of the chest for equal expansion and adequate depth Listening for air flow and any obstructive sounds Feeling the air coming from the patients nose and mouth as well. *A normal adult, has a resting breathing rate of about 12-20 breaths per minute. Are there noisy respirations, wheezes, gurgling, gasping, any cyanosis, absent, slow or rapid

Difference between respiratory distress and failure Respiratory Distress Respiratory Failure Retractions Decreased consciousness Two word sentences Poor chest rise Pursed lips

Pale, cool, mottled Cyanosis Minimal air movement Indications for different oxygen delivery devices Nasal cannula Fairly stable patients Low-flow oxygen from 2-6 L/minute, 35 to 50% Non-rebreather Patients with serious s/s such as severe shortness of breath, severe

chest pain, congestive heart failure and carbon monoxide poisoning as well as s/s of shock Delivers high flow oxygen at 8-15 L/minute, and concentrations as high as 90% with a reservoir bag Ventilatory Assist and Measurement of Adequacy Oxygenate vs. ventilate Many patients with respiratory disease need only comfort care Some may need minimal oxygen delivery via a nasal cannula or even a mask Some may require intervention to the

point of BVM ventilation to assist with their breathing inadequacy BVM device consists of a reservoir and one way valve. With oxygen attached from 10-15 L/min it can deliver up to a concentration of up to 90%. This is more reliably accomplished as a two-person skill, although can be done by one person. *Introduce ETCO2(optional) Rescue Breathing: Adults vs. Children Adult rescue breathing Kneel at patients head maintaining an open airway. Assure the mouth is clear of any fluids or foreign

bodies Select the proper mask size Place the mask on the patients face Seal the mask, forming an E C with your fingers around the chin and mask Lifting the chin into the mask, then squeeze the bag and visualize chest rise Add supplemental oxygen Rescue breath once every 5-6 seconds Child/infant rescue breathing Due to the smaller anatomy and airways of children you will not

have to use as much of a head tilt. Also, padding under their torso may assist in maintaining an open airway. Use a sniffing position in most cases for infants. Too much of a tilt and you will close off the airway. The rate is also slightly faster with children with a rescue breath given once every 3-5 seconds Indications for oxygen Dont deny any patient oxygen with shortness of breath or who is clearly having difficulty breathing. Oxygen therapy for Acute Coronary syndrome and

stroke patients should be guided by measured oxygen levels (SpO2). In the absence of SpO2 measurements, then it is reasonable to give 2 L/min nasal cannula. A patient presenting with ACS and stroke with signs and symptoms of dyspnea, shock and heart failure, it is also reasonable to administer high flow oxygen via a nonrebreather mask. Safety Considerations & Hazards of Oxygen Administration Highly pressurized cylinders Highly combustible with any spark, flame, heat or oily substance Handle carefully and always turn the tank off when not in use and release the pressure in the regulator, storing the tank in a safe place within a sturdy carrying case to avoid damage.

Pulse oximetry pros and wos Supplemental oxygen can be lifesaving but use if carefully and only after youve thoroughly assessed your patient for a need Summary Know the difference between respiration and ventilation Determining whether the patient is breathing adequately vs. inadequately Knowing how to effectively treat respiratory arrest and failure Adequately using the different oxygen masks for effective delivery when appropriate Knowing the hazards of oxygen delivery

Module 1-Section II Cardiac (Adult and Pediatric Cardiac Arrest/ROSC) Objectives Discuss some A & P of the cardiovascular system State the five links in the Chain of Survival Discuss recognition of the critical cardiac patient

Describe the current techniques of one and two rescuer adult CPR Describe the current techniques of one and two rescuer pediatric CPR List the signs of effective CPR Describe the complications of performing CPR Describe the indications and use of an automated external defibrillator Identify the signs associated with Return of Spontaneous Circulation A & P of the Cardiovascular System The Circulatory System Heart Atrium Ventricle

Arteries Veins Capillaries Carotid arteries Brachial arteries Radial arteries 5 Links in the Chain of Survival Recognition/Activation of EMS Immediate high-quality CPR Rapid defibrillation Basic and advanced EMS ALS and post arrest care

Recognition of the Critical Cardiac Patient Heart Attack (Myocardial Infarct) Usually immediate and severe and may not go away with rest or nitroglycerin Angina Pectoris Typically responds to nitroglycerin and goes away with rest Congestive Heart Failure Usually a pump issue with fluid back up into the lungs with

primarily shortness of breath and typically no chest pain Current Techniques of One and Two Rescuer Adult CPR *Most important points to remember during CPR Assessing carotid pulse at least 5 but no more than 10 seconds Proper hand placement Proper depth at least 2 inches Allow full chest recoil Compress at a rate of 100-120 per minute 30:2 ratio Current Techniques of One Rescuer

Pediatric CPR Infant CPR ( under 1 year) Assess brachial pulse Proper 2-finger placement Proper depth 1 inches Proper rate 100-120 per minute 30:2 one person, 15:2 two person

Child CPR ( over 1 year) Assess carotid pulse Proper 1 hand or 2 hand placement depending on the size of the child Proper depth 2 inches Proper rate 100-120 per minute 30:2 one rescuer, 15:2 two rescuer Signs of Effective CPR Pulse with compression Skin color improves Chest visibly rises during ventilation Compression and

ventilations delivered at appropriate rate and depth Return of spontaneous circulation Complications of Performing CPR Broken ribs Gastric distention Regurgitation Use of Automated External Defibrillator 70% of all out-of-hospital cardiac arrest patients have irregular heart electrical rhythms

Defibrillator provides the greatest chance of survival when delivered early The third link in the chain of survival Vary in design, be familiar with your device Return of Spontaneous Circulation Signs of life are observed Patient breathing Patient movement Assure proper ventilation and oxygenation Avoid excessive ventilation (over-bagging) Reduces cardiac output

*Remember most deaths following ROSC occur within the first 24 hours - transport to most appropriate facility Summary Recite the steps in the chain of survival Know the s/s of a critical cardiac patient Know how to perform one and two person adult and pediatric CPR Knowing how to use the AED Recognizing signs of effective CPR and the complications of doing CPR Recognizing Return of Spontaneous Circulation signs

Module I Section III Neurological Emergencies, Stroke, CNS Injuries Objectives Define altered mental status

State common causes of altered mental status Define types of seizures Explain causes of seizures Explain complications associated with seizures Discuss signs and symptoms of stroke Explain major causes of stroke Discuss importance of knowing the timeline of stroke events Discuss management of the stroke victim Identify the signs and symptoms of a patient with traumatic brain injury (TBI) Discuss the current research and practices for the use of selective spinal immobilization Altered Mental Status A sudden or gradual decrease in the patients

level of responsiveness. A V P U Common Causes of Altered Mental Status A alcohol E - epilepsy I - infection O - overdose U - uremia T - trauma I - insulin P - psychosis S - stroke

Common Types of Seizures Generalized Grand mal (shaking movements involving the entire body) Absence Brief lapse of consciousness, formerly known as petit mal seizures Status Epilepticus Causes of Seizures High fever

Trauma Stroke Shock Infection Poisoning Diabetic Overdose Complications Associated with Seizures Aspiration Bone and spine fractures Brain damage from lack of oxygen and/or depletion of glucose Dehydration Signs and Symptoms of Stroke

Vary dependent on what part of the brain is affected. They can be similar to that of a head injury, hypoglycemia or seizures. The patient can be alert, confused or unresponsive. They could describe a headache and the worst headache of their lives Facial drooping, one-sided weakness, slurring speech Major causes of stroke Hypertension

High cholesterol Heart disease Diabetes Smoking Importance of knowing the timeline of stroke events Stroke patients can have favorable outcomes if recognized and treated early within a critical time period. 3 hours from the onset of symptoms a clot-buster medication can be administered Its extremely important to retrieve the timeline from family members or loved ones as to the exact time the patient was last seen well or normal Transport to the appropriate facility quickly is also an

important factor Management of the stroke victim Manage ABCs Recognize S/Ss Determine timeline Perform CPSS Place in recovery position Identify signs and symptoms of traumatic brain injury Physical

Headache N/V Balance problems Dizziness Visual problems Fatigue Light sensitivity Noise sensitivity Numbness/tingling

Cognitive Mental fogginess Feeling slowed down Difficulty concentrating Difficulty remembering Signs and symptoms of traumatic brain injury, cont. Emotional

Irritability Sadness Heightened emotions Nervousness Sleep Drowsiness Sleepiness less than/more than usual Trouble falling sleep Care and education of the concussion patient

Patient should be transport if a concussion is suspected If the patient refuses, educate them on the warning s/s and seeking medical attention: One pupil larger than the other Drowsiness or cannot be awakened

A headache that gets worse and wont go away Weakness, numbness, or decreased coordination Repeated vomiting or nausea Slurred speech Convulsions or seizures Difficulty recognizing people or places Increasing confusion, restlessness, unusual behavior or agitation Loss of consciousness, even brief EMS spinal precautions and use of the long backboard Follow local protocol* Remember a patient with altered mental status may not be able to accurately relay injury symptoms when you assess, always be cautious with traumatic brain injured patients and factor mechanism of injury in your

decision-making process for immobilization. Summary Identifying causes of altered mental status, A-E-I-O-U-T-IP-S, and the care and treatment of each Know the different types of seizures and how they present Describe the s/s of stroke and knowing the importance of having the exact timeline of patients last known normal state Identifying traumatic brain injury and the care and treatment for same Know the current practice for spinal immobilization EMR Refresher Module II

Medical Emergencies/Operations ENDOCRINE/BEHAVIORAL/IMMUNOLOGICAL/ TOXICOLOGICAL/INFECTIOUS DISEASE/OB/FIELD TRIAGE-DISASTERS/MCIS/ EMS PROVIDER HYGIENE SAFETY & VACCINE/ EMS CULTURE OF SAFETY Module II Section I Endocrine Emergencies Objectives Explain the role glucose plays on the cells Identify symptoms commonly associated with hypoglycemia Identify symptoms commonly associated with hyperglycemia/diabetic coma

Describe interventions for hypo/hyperglycemic patients Role glucose plays on the cells Glucose is an essential nutrient for the cells. Fuel for cells Ensures proper brain and cell functioning Changes in levels may result in altered behavior Symptoms associated with Hypoglycemia Pale, moist, cool skin Rapid, weak pulse Dizziness or headache Confusion or headache

Confusion or unconsciousness Sweating Hunger Rapid onset of symptoms (within minutes) Symptoms associated with Hyperglycemia Slow onset and changes in mental status Rapid breathing, sweet breath odor Dehydration, pale, warm, dry Weakness, nausea, vomiting Weak, rapid pulse Polyuria, polydipsia, polyphagia Interventions for Hypo/Hyperglycemia patients Hypoglycemia

Hyperglycemia Ensure open airway, adequate breathing, circulation and ability to swallow Ensure open airway, adequate breathing, circulation and ability to swallow Check glucose Check glucose If able to swallow and alert can

have the patient drink juice Supportive care until transport arrives, place in recovery position *Follow local protocol regarding oral glucose administration Summary - Understanding the role that glucose plays on the cells - Recognizing the signs and symptoms of a patient with a glucose emergency whether hypoglycemic or hyperglycemic and treat accordingly

Module II Section II Behavioral Emergencies Objectives Define a behavioral crisis List factors that contribute to a behavioral emergencies Describe the components of a mental status exam Recognize signs and symptoms of the abused patient Describe assessment and treatment of the violent patient

State the risk factors for suicide Describe care and approach in dealing with the suicidal patient Behavioral Crisis What is a behavioral crisis? A sudden disruptive event such as a physical illness, a traumatic injury, or the death of a loved one which causes a person to exhibit abnormal behavior that is unacceptable or cannot be tolerated by the patient himself or by friends, family or the community.

Main factors that contribute to Behavioral Emergencies Medical conditions such as uncontrolled diabetes, stroke, brain injuries, high fevers, infections Physical trauma Psychiatric illnesses such as depression, panic disorders Mind-altering substances such as alcohol and drugs Situational stresses from emotional traumas such as death of a loved one or serious injury to a loved one Components of Mental Status Exam Mechanism of injury or nature of illness? Injuries/illnesses can cause altered

behavior Medication side effects Mental health history General appearance Dress Grooming

Posture Wringing of hands Facial grimaces Mannerisms Actions Violence Components of mental status exam, cont. Speech

Spontaneous or pressured Slow or fast Soft or loud Understandable or not Appropriate or inappropriate Mood Area of thought

Racing thoughts Hallucinations Obsessive Delusions Suicidal Unconnected Disturbed or distorted Signs and symptoms of the abused patient Broken bones Cuts Head injuries Bruises of varying stages of healing Burns (patterned) Scars from old injuries Internal injuries may be caused

Person may be withdrawn, underweight or malnourished for age from neglect Assessment and treatment of the Violent Patient Assess the scene and your safety first and foremost, identify the need for law enforcement Immediately attempt to establish verbal or eye contact with the patient to begin the process of creating a rapport with your patient Communication is key Observe the patients behavior, mannerisms, speech, is he/she yelling, posture

Is there substance abuse involved? Have an escape route Empathy can often defuse tense situations Risk factors for Suicide History of depression and other mental disorders Previous suicidal gestures/attempts History of family/child abuse (non-accidental trauma) Feelings of hopelessness Unwillingness to seek mental health care (stigma attached) Feeling of being isolated from others History of impulsive of aggressive behavior Inability to access mental health Recent diagnosis of a serious health, especially an illness that signals a loss of independence Recent loss of a loved one, job, money or social loss

Access to firearms PTSD Alcohol or drug abuse Loss of a relationship Care and approach in dealing with the suicide patient Protect yourself and others first from further harm Does the patient still have a weapon or items on their person to do them harm? Gather the information regarding the episode Protect ABCs Control hemorrhage, treat any injuries Dont judge the patient Listen, be supportive

Dealing with Agitated Delirium/Excited Delirium Patients Stay calm, and do not cause more harm to the patient This state is caused by a sudden onset of extreme agitation and extremely irrational or combative behavior Bizarreness, aggressiveness, agitation, ranting, hyperactivity, paranoia, panic Resulting from substance intoxication, psychiatric illness, alcohol withdrawal, head trauma, or a combination of these Patient can have hypertension, tachycardia, diaphoresis, dilated pupils, tachypnea, abnormal tolerance to pain, hyperthermia, noncompliance, and endless endurance and strength May lead to respiratory and cardiac arrest Restraints may increase the risk

Summary Describe what a behavioral crisis is and how to deal with a patient having a behavioral crisis. Define the many forms of abuse Be able to care for the violent patient Know the components of the mental status exam Be able to state the risks for suicide and how to approach the suicidal patient Know how to approach and care for the patient in a state of agitated delirium Module II Section III Toxicology & Immunological Emergencies Objectives Define poison Describe signs and symptoms and how to treat each of the four routes

of exposure to a poison Discuss the physiology related to allergies and anaphylaxis Differentiate between a mild/localized allergic reaction and anaphylaxis Explain the actions of medications used to treat anaphylaxis Describe signs and symptoms of drug overdose caused by different substances Identify common synthetic stimulants and natural or synthetic THC (tetrahydrocannabinol) Recognize the effects Identify common opioids Recognize the effects Explain common treatment options for a person experiencing opioid overdose

What is a Poison? A substance that causes illness or death when eaten, drank, inhaled, injected, or absorbed in not necessarily large quantities. Signs and Symptoms of Ingested Poisons Ingestion occurs when a poison enters the body through the mouth and is absorbed in the digestive system.

Nausea Vomiting Abdominal pain Diarrhea Chemical burns Odors Stains around the mouth Activated charcoal*

Signs and Symptoms for Inhaled Poisons Inhalation occurs when a poison enters the body through the mouth or nose and is absorbed by the mucous membranes lining the respiratory system. Respiratory distress

Dizziness Cough Headache Hoarseness Confusion Chest pain Protect yourself, remove patient from the source Secure airway, breathing, provide oxygen Signs and Symptoms of Injected Poisons Injection occurs when a poison enters the body through a small opening in the skin and spreads through the circulatory system.

Tenderness at the site Swelling Red streaks Weakness

Dizziness Localized pain Itching Hives Rapid, weak pulse Rapid, shallow breathing Identify the source but protect yourself Signs and Symptoms of Absorbed Poisons Absorption occurs when a poison enters the body through intact skin and spreads through the circulatory system.

Traces of powder or liquid on the skin Inflammation or redness on the skin Chemical burns Rash Burning Itching Nausea and vomiting Dizziness

Shock Protect yourself, obtain haz mat, remove the patient from the source, brush before you flush. Comparing Allergy to Anaphylaxis Allergic reaction Hyperactive, localized immune response to an allergen Some histamine is released Localized: redness, swelling, hives, itching May cause nausea, vomiting, and/or diarrhea Usually requires minimal supportive treatment

Anaphylaxis Multiple body systems are affected Life threatening reaction of the immune system to an allergen Large quantities of histamine are released throughout the body Vasodilation and increased capillary permeability May lead to shock Bronchoconstriction and mucous production May lead to respiratory distress Swelling of the upper airways

Medication used to treat anaphylaxis Patient assisted Epi Pens *Follow local protocol Ensure adequate airway, ventilation and oxygenation Assist patient with epinephrine auto-injector if available* Signs and symptoms of drug overdose from different substances Slow, difficult, shallow breathing, or no breathing Small or pinpoint pupils Weak pulse

Low blood pressure Blue nails and lips Drowsiness Disorientation Delirium Coma Restlessness Irritability Hallucinations paranoia Common synthetic stimulants Amphetamines Cocaine Bath salts

THC (tetrahydrocannabinol) Common Opioids Heroin Morphine Oxycodone Codeine Fentanyl Hydrocodone Hydromorphone Methadone Treatment for opioid overdose Naloxone (Narcan) Opioid antagonist Reverses CNS and respiratory

depression due to opioid overdose NOT effective against nonopioid drugs First responders may administer intra-nasally* *Follow local protocols Summary Know the four routes of exposure to a poison, the care and treatment for each and s/s of each Recognizing a drug overdose, the many substances involved causing overdose, s/s and care for the overdose patient Differentiate between allergic reaction and anaphylaxis

Describe what THC is. Module II Section IV Infectious Diseases, EMS Provider Hygiene Safety & Vaccine Objectives

List common hazards encountered by EMRs Describe three routes of disease transmission Describe drug resistant infections Describe how the transmission of influenza virus occurs Understand the mode of transmission of airborne and bloodborne pathogens Assess the differences between sepsis and septic shock Describe the standard precautions for preventing infectious diseases Identify proper handwashing technique Identify appropriate use of alcohol-based hand cleaner Discuss the CDCs recommendations of vaccines for healthcare providers Assess eye safety indications and measures Common Hazards Encountered by EMRs

Infectious diseases Traffic Crime and violence Crowds Electrical hazards Fire Hazardous materials Unstable objects Sharp objects Animals Environmental conditions Special rescue situations Three routes of disease transmission Infected blood

Contact with airborne droplets Direct contact with infectious agents Drug resistant infections Microbes are resistant to the effects of medications/treatments Difficult to treat Anyone is susceptible; some must be more cautious Weakened immune systems Open skin wounds

Recent surgery Invasive procedures (PICC lines, IVs, in-dwelling catheters, etc.) Common resistant infections: MRSA VRE VRSA TB Clostridium difficile (C-Diff)

How the transmission of influenza virus occurs Spread from person to person: Large particle respiratory droplet transmission Contact with droplet contaminated surfaces Airborne transmission by small-particle residue of evaporated droplets Typical incubation period is 1-4 days Contagiousness begins the day before symptoms start and lasts 5-10 days Children may be contagious several days before becoming symptomatic, lasting ten or more days after onset Severely immunocompromised people can shed virus for weeks to months

Mode of transmission Bloodborne Patients blood is splashed or sprayed into your eyes, nose or mouth or into an open sore or cut You have blood on your hands and touch your own eyes, nose, mouth, or an open sore or cut A needle or sharp object that had a patients blood on it stuck or stabbed you Broken glass from a motor vehicle crash breaks your skin and has blood on it from the patient.

Airborne Patient coughs or sneezes and you inhale these droplets from the air. Some droplets remain on surfaces of equipment and if not cleaned or handled properly can transfer to you after it has dried Sepsis and Septic Shock Bodys response to infection Most common in older adults Can be life-threatening Chemicals released into the bloodstream as a result of an

infection, triggering an inflammatory response throughout the body Eventually if left untreated can develop into shock, in which blood pressure can plummet, mental status will be severely altered, may or may not present with fever Standard precautions for preventing infectious disease Always wear gloves! Always wear eyewear when appropriate! Always wash your hands! Place all sharps into a puncture-resistant container Even though saliva has not been proven to transmit HIV use a

face shield when dealing with a patients airway Proper Hand-Washing Technique Wash you hands before and after eating, before and after handling each patient once your gloves are removed. Wash you hands in clean, warm running water. Apply soap (does not have to be anti-bacterial), make a good lather Rub between fingers, around nails, all surfaces for at least 20 seconds, singing happy birthday Thoroughly rinse and dry then turn the faucet off with the used paper

towel Use of alcohol-based hand cleaner Should contain at least 60% alcohol Reduces number of germs Does not eliminate all types of germs Does not kill viruses Ineffective when hands are visibly dirty CDCs Recommendations of Vaccines for Healthcare Providers Prevention begins by maintaining your personal health Recommendations:

Hepatitis B Influenza (annually) Measles, mumps, and rubella (MMR) (typically a one-time vaccination) Varicella (chickenpox) vaccine or having had chickenpox Tetanus, diphtheria, pertussis (Tdap) (every 10 years) *Most of these vaccines are given as children, some may need boosters. Keep your vaccines up to date. Eye and Face Protection Blood splatters are a significant possibility in most trauma situations and some medical Goggles Face Shields

Safety glasses Full face respirators Summary Describe some common hazards encountered by EMRs Remember the routes of disease transmission: Differentiating between airborne and bloodborne pathogens Know the difference between sepsis and septic shock Using standard precautions and knowing the proper procedure for hand-washing Understand your vaccination options and recommendations as an EMR Module II Section V OB Emergencies Objectives

Explain the anatomy and function of the female reproductive system State the stages of labor Explain the procedures for normal child delivery in the field Determine the need for neonatal resuscitation during delivery Describe the routine care of a newborn not requiring resuscitation Describe the care and treatment of some complications that can occur during childbirth Anatomy and Function of the Female Reproductive System Uterus Birth canal Vagina

fetus Placenta Umbilical cord Stages of Labor First stage Contractions start, hopefully the bag of waters breaks and the bloody show is expelled. Second stage Birth of the newborn Third stage Delivery of the placenta (afterbirth)

Procedures for normal child delivery REMAIN CALM! Prepare you equipment Wash your hands don your gloves and eye protection Mom will do most of the work you will guide the baby and prevent an explosive delivery. Support the baby, remember he/she will be slippery when born Keep the babys head at the level of the mothers vagina Dont pull on the newborn, make sure the cord is not around the babys neck, if so, gently slip it around If the bag of waters has not been broken you can tear it open There is no need for the EMR to cut the cord. Determine a need for neonatal resuscitation

Most newborns will begin to breath just after birth with minimal stimulation after their airway is cleared. Some may need a little more assistance. If the newborn does not cry and breathe on his or her own within the first minute after birth, proceed with the following: Tilt the head down to the side to encourage drainage and clear secretions from nose and mouth Suction the mouth then nose with a bulb syringe Stimulate by flicking the soles of feet or rubbing the babys back gently, if no response Begin mouth to mouth or nose breathing with gentle puffs just enough for chest rise Reassessing every 30 seconds respirations and pulse to assure they reach at least 40 breaths or 100 heart beats before going to the next step If not and pulse is not yes increased and is below or at 60 begin chest compressions and make sure oxygen has been added to your ventilations

Routine care of newborn not requiring resuscitation As soon as the newborn is delivered place him/her between mothers legs onto a clean towel at the level of her vagina. After suctioning and drying assure newborn is breathing adequately Place the newborn onto mothers abdomen if both are stable When umbilical cord stops pulsating clamp or tie it, there is no need to cut it unless you have the sterile equipment to do it. Note the time of birth

Complications of Pregnancy and Childbirth Ectopic pregnancy Severe abdominal pain, s/s of shock, pale skin, dizziness, rapid pulse Miscarriage and vaginal bleeding Spontaneous abortion, delivery of an incomplete or underdeveloped fetus. A fetus before 20 gestation cant survive Premature birth Newborn weighing less than 5 pounds or delivered before 36 weeks is considered a preemie, can lose body heat faster, is smaller, skin is thinner, requires prompt transport. Unbroken bag of waters Rare occurrence but needs to be broken before baby can be born, be careful not to

injure the newborn when you do break it. Prolapse of the umbilical cord Appears through the vaginal opening before the baby at delivery. Can become compressed by the babys head upon delivery, thus cutting of babys blood supply which will compromise oxygen delivery. Serious emergency Summary Know the anatomy and function of the female reproductive system Be able to define the stages of labor Differentiate between a normal newborn delivery and one needing resuscitation Define the steps of a newborn resuscitation Describe some complications of pregnancy/delivery

Module II Section VI Field Triage-Disasters/MCI Objectives Define a mass-casualty incident Describe the EMRs role in a mass-casualty incident Discuss CDCs field triage decision scheme Discuss different triage methods: Discuss five components of NIMS/six ICS features Discuss terrorism awareness

Mass Casualty Incident Mass Casualty Incident (multiple-casualty incidents) more than one sick or injured person, often times more than one jurisdiction can handle alone. Can range from a serious motor vehicle accident to a burning building, to an explosion, all involving numerous people. EMR role in a mass casualty incident Goal: Doing the greatest good for the greatest number First surveying the scene, assuring your safety and

looking for hazards, doing a size-up, giving an overall estimation of what the situation may be. Secondly, sending information via radio report: Where What Any hazards How many (approximate) Type of help needed Thirdly, sorting begins!

4 Steps of the CDCs Field Triage Decision Scheme Step I Assess vital signs and level of consciousness GCS Resp Rate Systolic BP (peripheral pulses, perfusion) Step II Assess anatomy of injury Step III Assess mechanism of injury Step IV

Assess special patient or system considerations Considering priority transport to trauma center for older adults, pediatrics, burns, OB patients, anticoagulant and bleeding disorders Different triage methods Salt Sort Assess Lifesaving interventions Treatment/transport

Start Simple Triage And Rapid transport JumpStart (pediatric version of START) Five Components NIMS/Six Major Features

of ICS NIMS Provides a comprehensive, consistent, and unified approach to handling emergency incidents. Preparedness Communications and information management Resource management Command and management Ongoing management and maintenance ICS Part of the command and

management component of NIMS Standardization Command Planning/Organizational structure Facilities and Resources Communications Information Management Professionalism Terrorism Awareness Terrorism the systematic use of violence by a group to intimidate a population of

government to achieve a political goal. Weapons of Mass Destruction Potential Targets and Risks Agents and Devices Your response Summary Be able to recognize a mass casualty Know what your role as an emergency responder is in the event of a mass casualty Know the START/JumpSTART triaging steps Be familiar with the NIMS/ICS system Be aware of a terrorist event and your role in that event

Module II Section VII EMS Culture of Safety Objectives Define culture of safety Identify and explain the six core elements necessary to advance an EMS culture of safety Identify the role of the EMS providers in establishing a culture of safety within EMS organizations EMS Culture of Safety The value and priority placed on worker and public safety by everyone in every group at every level of the organization. The extent to which individuals and groups will commit to personal responsibility for safety; act to preserve

Enhance and communicate safety concerns Strive to actively learn, adapt and modify behavior based on lessons learned from mistakes Six Core Elements Necessary to Advance an EMS Culture of Safety Just Culture Development of environments in which EMS personnel are safe to report errors Assess risks in order to identify means of overcoming factors that contribute to errors Coordinated support and resources Creation of a guidance and resource coordination body EMS Safety Data System Data driven decisions and policies related to EMS safety can only be made if all data is accessible on a national level

EMS Education Initiatives Safety starts with EMS leaders and educators and involves everyone EMS Safety Standards Safety standards for patient and responder safety must be developed using data and evidence Requirements for reporting and investigation Mandates for reporting safety are necessary so a common language and data set can be created to improve responder and patient safety What is your role as an EMS Provider in establishing a Culture of Safety within your organization? What changes are needed to encourage the

development of a culture of safety? How are mistakes handled if one is made during a patient care encounter? How should it be handled if applying the concept of Just Culture? *Blaming or punishing is not an option in Just Culture Summary As an EMT it is your responsibility to promote safety in every aspect of your profession: Safe transportation of your crew members to and from a scene

Safe transportation of your patient to the hospital Promote safe actions while on the scene Promote safety while training Assist leadership and following policies and guidelines for the promotion of a culture of safety EMR Refresher Module III Skills CARDIAC ARREST MANAGEMENT/AED/BLEEDING CONTROL AND SHOCK MANAGEMENT/OXYGEN ADMINISTRATION/MEDICAL PATIENT ASSESSMENT WITH BASELINE VITALS/TRAUMA PATIENT ASSESSMENT WITH BASELINE VITALS

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