DOT National Standard EMT-Intermediate/85 Refresher

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training

QuickTime™ and a

decompressorare needed to see this picture.

QuickTime™ and a decompressor

are needed to see this picture.

DOT National Standard

EMT-Intermediate/85 RefresherDOT National Standard

EMT-Intermediate/85 Refresher

Welcome!


QuickTime™ and a




MEDICAL EMERGENCIES• Allergic reaction• Possible overdose• Near-drowning• ALOC• Diabetes• Seizures• Heat & cold

emergencies• Behavioral emergencies• Suspected

communicable disease

• Allergic reaction• Possible overdose• Near-drowning• ALOC• Diabetes• Seizures• Heat & cold

emergencies• Behavioral emergencies• Suspected

communicable disease

• ■ Provide ventilatory support for a patient

• ■ Attempt to resuscitate a patient in cardiac arrest

• ■ Provide care to a patient experiencing cardiovascular compromise

• ■ Provide post resuscitation care to a cardiac arrest patient

• ■ Provide ventilatory support for a patient

• ■ Attempt to resuscitate a patient in cardiac arrest

• ■ Provide care to a patient experiencing cardiovascular compromise

• ■ Provide post resuscitation care to a cardiac arrest patient


QuickTime™ and a



are needed to see this picture.MEDICAL EMERGENCIES

• Perspective• Pathophysiology• Epidemiology• PE & Diagnostic

Findings• S/S• Differential

considerations• Tx

• Perspective• Pathophysiology• Epidemiology• PE & Diagnostic

Findings• S/S• Differential

considerations• Tx


QuickTime™ and a




• Do not start CPR– Documented pulseless & nonbreathing for

more than 15 min by a reliable witness who has observed the pt carefully

– Pulseless & nonbreathing w/ signs of prolonged lifelessness (e.g. rigor mortis, lividity)• Burns or decapitation

• Do not start CPR– Documented pulseless & nonbreathing for

more than 15 min by a reliable witness who has observed the pt carefully

– Pulseless & nonbreathing w/ signs of prolonged lifelessness (e.g. rigor mortis, lividity)• Burns or decapitation


QuickTime™ and a




• Note: downtime for initiation of CPR is extended from 15min to 30min in certain SPECIAL CASES– Cold water drowning– Hypothermia– Barbiturate OD– Electrocution– Lightning strike

• Note: downtime for initiation of CPR is extended from 15min to 30min in certain SPECIAL CASES– Cold water drowning– Hypothermia– Barbiturate OD– Electrocution– Lightning strike


QuickTime™ and a




Cardiac Arrest• Adult with AED

– If pt is <14yr or shorter than Broselow tape (5feet)- Medical Arrest Without AED or Pediatric Medical Arrest with AED

– If pt is a newborn go to protocol - Pediatric -Newborn resuscitation

• Adult with AED– If pt is <14yr or shorter than Broselow tape

(5feet)- Medical Arrest Without AED or Pediatric Medical Arrest with AED

– If pt is a newborn go to protocol - Pediatric -Newborn resuscitation


QuickTime™ and a




Cardiac Arrest

• 1) Confirm arrest• Call for ACLS backup ASAP• Check breathing, give 2 breaths if indicated, &

check pulse 6 seconds

• 1) Confirm arrest• Call for ACLS backup ASAP• Check breathing, give 2 breaths if indicated, &

check pulse 6 seconds


QuickTime™ and a




Cardiac Arrest

• Assessment– Quickly obtain info (15-30sec) from

witnesses to determine whether resuscitation should be initiated & by what means.

– As time allows, obtain additional info including preceding events & symptoms, PMH.

• Assessment– Quickly obtain info (15-30sec) from

witnesses to determine whether resuscitation should be initiated & by what means.

– As time allows, obtain additional info including preceding events & symptoms, PMH.


QuickTime™ and a




Cardiac Arrest

• If downtime of the pt is known to be <4min, then initiate resuscitation w/ the AED

• If the downtime of the pt is unknown, or is known to be >4min, then initiate resuscitation w/ CPR

• If downtime of the pt is known to be <4min, then initiate resuscitation w/ the AED

• If the downtime of the pt is unknown, or is known to be >4min, then initiate resuscitation w/ CPR


QuickTime™ and a




Cardiac Arrest

• Apply AED– Turn on AED & follow prompts

• After initial rhythm analysis, the AED will either recommend a shock or not. Allow the AED to deliver a shock as indicated

• Apply AED– Turn on AED & follow prompts

• After initial rhythm analysis, the AED will either recommend a shock or not. Allow the AED to deliver a shock as indicated


QuickTime™ and a




Cardiac Arrest

• Airway– Secure airway utilizing OPA/NPA or ALS

airway (Combitube or King)

• Airway– Secure airway utilizing OPA/NPA or ALS

airway (Combitube or King)


QuickTime™ and a




Cardiac Arrest

• CPR/AED- cycle 1– 1 or 2 rescuer CPR (30:2). Compress

100/min– Ventilate

• Do not over-inflate• Do not ventilate too quickly

• CPR/AED- cycle 1– 1 or 2 rescuer CPR (30:2). Compress

100/min– Ventilate

• Do not over-inflate• Do not ventilate too quickly


QuickTime™ and a




Cardiac Arrest

• CPR/AED- cycle 1– If AED is already attached to the pt,

perform CPR until the AED prompts for the next analysis (approx 2min). Do not check pulse before AED analysis• If AED states “shock advised” follow prompts

on AED to shock the pt– After shock is done, the AED will state “shock

delivered”. Do not check pulse

• If AED states “no shock advised” then check carotid pulse for 6 seconds

– If there’s a pulse>>>

• CPR/AED- cycle 1– If AED is already attached to the pt,

perform CPR until the AED prompts for the next analysis (approx 2min). Do not check pulse before AED analysis• If AED states “shock advised” follow prompts

on AED to shock the pt– After shock is done, the AED will state “shock

delivered”. Do not check pulse

• If AED states “no shock advised” then check carotid pulse for 6 seconds

– If there’s a pulse>>>


QuickTime™ and a




Cardiac Arrest

• If AED is not yet attached to pt, perform 2min of CPR, then attach AED to pt. After initial rhythm analysis, the AED will either recommend a shock or not– If AED states “shock advised” follow prompts on

AED to shock the pt. After shock is done, the AED will state “Shock Delivered”. Do not check pulse

– If AED states “no shock advised”, then check carotid pulse for 6sec.

• If pt has a palpable pulse or spontaneous respirations >>

• If AED is not yet attached to pt, perform 2min of CPR, then attach AED to pt. After initial rhythm analysis, the AED will either recommend a shock or not– If AED states “shock advised” follow prompts on

AED to shock the pt. After shock is done, the AED will state “Shock Delivered”. Do not check pulse




QuickTime™ and a




Cardiac Arrest

• CPR/AED - cycle 2– Perform CPR until AED prompts for the next

analysis (approx 2min). Do not check pulse before AED analysis

– If AED states “shock advised” follow prompts on AED to shock the pt. After shock is done, the AED will state “Shock Delivered”. Do not check pulse



• CPR/AED - cycle 2– Perform CPR until AED prompts for the next

analysis (approx 2min). Do not check pulse before AED analysis

– If AED states “shock advised” follow prompts on AED to shock the pt. After shock is done, the AED will state “Shock Delivered”. Do not check pulse




QuickTime™ and a



are needed to see this picture.Cardiac Arrest

• IV– Make 3 attempts

• If successful, bolus 1-Liter LR/NS (while simultaneously performing resuscitation)

• If unsuccessful- do NOT attempt to give resuscitation meds w/o IV access

– 1mg Epi 1:10,000 IVP– Atropine only if pt was NOT shocked in the most recent

cycle– Lidocaine administer only if pt WAS shocked in the most

recent cycle 100mg IVP over 2 minutes

• IV– Make 3 attempts

• If successful, bolus 1-Liter LR/NS (while simultaneously performing resuscitation)

• If unsuccessful- do NOT attempt to give resuscitation meds w/o IV access

– 1mg Epi 1:10,000 IVP– Atropine only if pt was NOT shocked in the most recent

cycle– Lidocaine administer only if pt WAS shocked in the most

recent cycle 100mg IVP over 2 minutes


QuickTime™ and a




• Note– Most AEDs are programmed to analyze heart

rhythm in 2min intervals• Once IV meds are introduced into the resuscitation, CPR

should be performed for 3 min after each round of meds• The parkmedic may need override the automatic cycling

of the AED

• Note– Most AEDs are programmed to analyze heart

rhythm in 2min intervals• Once IV meds are introduced into the resuscitation, CPR

should be performed for 3 min after each round of meds• The parkmedic may need override the automatic cycling

of the AED


QuickTime™ and a




• CPR/AED- cycle 3– Perform CPR for 3 min after all meds are administered

• Do not check pulse before AED analysis– If AED states “shock advised”- follow prompts. After shock is done,

the AED will state “shock delivered”. Do not check pulse– If AED states “no shock advised”, then check carotid pulse for 6 sec

» If pt has a palpable pulse or spontaneous respirations>>>» If pt has no palpable pulse or spontaneous respirations-

continue resuscitation• Epinephrine 1mg 1:10,000 IVP• Atropine (administer only if pt WAS NOT shocked in most recent

cycle)– Perform CPR for 3 min after all meds are administered

• CPR/AED- cycle 3– Perform CPR for 3 min after all meds are administered

• Do not check pulse before AED analysis– If AED states “shock advised”- follow prompts. After shock is done,

the AED will state “shock delivered”. Do not check pulse– If AED states “no shock advised”, then check carotid pulse for 6 sec

» If pt has a palpable pulse or spontaneous respirations>>>» If pt has no palpable pulse or spontaneous respirations-




QuickTime™ and a




• CPR/AED- cycle 4• Do not check pulse before AED analysis

– If AED states “shock advised”- follow prompts. After shock is done, the AED will state “shock delivered”. Do not check pulse

– If AED states “no shock advised”, then check carotid pulse for 6 sec» If pt has a palpable pulse or spontaneous respirations>>>» If pt has no palpable pulse or spontaneous respirations-



• CPR/AED- cycle 4• Do not check pulse before AED analysis






QuickTime™ and a




• CPR/AED - cycle 5• Do not check pulse before AED analysis



continue resuscitation• Epinephrine 1mg 1:10,000 IVP

– Perform CPR for 3 min after all meds are administered







QuickTime™ and a















QuickTime™ and a




• Reassess– If pt has a palpable pulse or shows signs of life, check pulse

q 3 min & provide appropriate ventilatory support– If not previously attempted make 3 attempt at IV placement– If pt was not given Lidocaine during resuscitation

• Hold for HR<80. • IV 100mg slow IVP over 5min (50mg IVP q 30min -max 3mg/kg)

• Reassess– If pt has a palpable pulse or shows signs of life, check pulse

q 3 min & provide appropriate ventilatory support– If not previously attempted make 3 attempt at IV placement– If pt was not given Lidocaine during resuscitation

• Hold for HR<80. • IV 100mg slow IVP over 5min (50mg IVP q 30min -max 3mg/kg)


QuickTime™ and a




• Transport if pt has a palpable pulse or transit time to healthcare facility is <10min

• Special Cases - transport if pt has a palpable pulse or transit time to healthcare facility <30min

• If return to spontaneous circulation, keep AED attached to pt in “off”mode. If pt rearrests, turn the AED back to “on” mode & restart CPR/AED cycle

• Transport if pt has a palpable pulse or transit time to healthcare facility is <10min

• Special Cases - transport if pt has a palpable pulse or transit time to healthcare facility <30min

• If return to spontaneous circulation, keep AED attached to pt in “off”mode. If pt rearrests, turn the AED back to “on” mode & restart CPR/AED cycle


QuickTime™ and a




• Cardiac Arrest– Check glucose

• Cardiac Arrest– Check glucose


QuickTime™ and a




• Differential Dx– Reversible causes

• Cardiogenic shock• Cardiac dysrhythmias• Hypovolemia• Tension pneumothorax• Pericardial tamponade• Respiratory arrest• Allergic reaction• Drug/medication/toxic ingestion• Hypothermia• Hyperthermia• Drowning• Electrical injury• trauma

• Differential Dx– Reversible causes

• Cardiogenic shock• Cardiac dysrhythmias• Hypovolemia• Tension pneumothorax• Pericardial tamponade• Respiratory arrest• Allergic reaction• Drug/medication/toxic ingestion• Hypothermia• Hyperthermia• Drowning• Electrical injury• trauma


QuickTime™ and a




• Perspective• Pathophysiology• Epidemiology• PE & Diagnostic Findings• S/S• Differential considerations• Tx

• Perspective• Pathophysiology• Epidemiology• PE & Diagnostic Findings• S/S• Differential considerations• Tx


QuickTime™ and a



are needed to see this picture.Questions?• References

– Marx, John A. ed, Hockberger & Walls, eds et al. Rosen’s Emergency Medicine Concepts and Clinical Practice, 7th edition. Mosby & Elsevier, Philadelphia: PA 2010.

– Tintinalli, Judith E., ed, Stapczynski & Cline, et al. Tintinalli’s Emergency Medicine A Comprehensive Study Guide, 7th edition. The McGraw-Hill Companies, Inc. New York 2011.

– Wolfson, Allan B. ed. , Hendey, George W.; Ling, Louis J., et al. Clinical Practice of Emergency Medicine, 5th edition. Wolters Kluwer & Lippincott Williams & Wilkings, Philadelphia: PA 2010.

• References– Marx, John A. ed, Hockberger & Walls, eds et al.

Rosen’s Emergency Medicine Concepts and Clinical Practice, 7th edition. Mosby & Elsevier, Philadelphia: PA 2010.

– Tintinalli, Judith E., ed, Stapczynski & Cline, et al. Tintinalli’s Emergency Medicine A Comprehensive Study Guide, 7th edition. The McGraw-Hill Companies, Inc. New York 2011.

– Wolfson, Allan B. ed. , Hendey, George W.; Ling, Louis J., et al. Clinical Practice of Emergency Medicine, 5th edition. Wolters Kluwer & Lippincott Williams & Wilkings, Philadelphia: PA 2010.

DOT National Standard EMT-Intermediate/85 Refresher

Documents

Transcript of DOT National Standard EMT-Intermediate/85 Refresher