Epinephrine Auto Injector A Lifesaving Tool Now In the Hands of
the EMT-B New Jerseys Hospital Service Corporation MONOC 2007 EMS
EDUCATION
Slide 3
Epinephrine Auto Injector A Lifesaving Tool Now In the Hands of
the EMT-B Immediate Treatment = Saved Lives = Saved Lives
Slide 4
OBJECTIVES At the conclusion of this program the EMT-B will
have the cognitive, psychomotor, and affective skills that are
needed to properly administer an Epinephrine Auto Injector to a
prehospital patient who is having an Anaphylactic reaction in
accordance with the NJ OEMS Policy
Slide 5
Describe the scope of the problem Describe the scope of the
problem Define Anaphylaxis Define Anaphylaxis Explain the
Epinephrine Auto Injector Policy Explain the Epinephrine Auto
Injector Policy Define role and responsibility of the Medical
Director, the First Aid Squad, the individual EMT-B, OEMS and MONOC
in this program Define role and responsibility of the Medical
Director, the First Aid Squad, the individual EMT-B, OEMS and MONOC
in this program Explain the importance of FAST care Explain the
importance of FAST care OBJECTIVES
Slide 6
Describe progressive pathophysiology of Anaphylactic Reactions
Describe progressive pathophysiology of Anaphylactic Reactions
Describe the Signs and Symptoms that an Anaphylaxis patient
presents with Describe the Signs and Symptoms that an Anaphylaxis
patient presents with List the common triggers that lead to an
Anaphylactic Reaction List the common triggers that lead to an
Anaphylactic Reaction List conditions that mimic Anaphylaxis List
conditions that mimic Anaphylaxis OBJECTIVES
Slide 7
OBJECTIVES Describe the actions, side effects, route, and
injection site for Epinephrine Auto Injector Describe the actions,
side effects, route, and injection site for Epinephrine Auto
Injector State when to use the pediatric dose of Epi and how to
estimate patient weight and age State when to use the pediatric
dose of Epi and how to estimate patient weight and age Describe the
procedure to follow to check for device expiration and drug clarity
Describe the procedure to follow to check for device expiration and
drug clarity State how to safely and properly dispose of an
Epinephrine Auto Injector State how to safely and properly dispose
of an Epinephrine Auto Injector
Slide 8
Describe proper patient assessment by an EMT-B for a
Anaphylaxis patient Describe proper patient assessment by an EMT-B
for a Anaphylaxis patient Explain the Procedure for an EMT-B to
follow to administer an Epinephrine Auto Injector Explain the
Procedure for an EMT-B to follow to administer an Epinephrine Auto
Injector Describe common errors in Auto Injector use Describe
common errors in Auto Injector use Describe proper Documentation
after use Describe proper Documentation after use OBJECTIVES
Slide 9
Describe the proper method to deliver Ventilations to patients
of all ages Describe the proper method to deliver Ventilations to
patients of all ages Explain the proper procedure for use of Basic
Airway Adjuncts by EMT-B Explain the proper procedure for use of
Basic Airway Adjuncts by EMT-B Describe how to deliver Quality CPR
Describe how to deliver Quality CPR Explain how the EMT-B can
assist ALS Explain how the EMT-B can assist ALS State where to find
more information State where to find more information
OBJECTIVES
Slide 10
Systemic allergic reaction Systemic allergic reaction Affects
body as a whole Multiple organ systems may be involved Onset
generally acute Onset generally acute Manifestations vary from mild
to fatal Manifestations vary from mild to fatal WHAT IS Anaphylaxis
? DEFINITION
Slide 11
Definitions & OEMS Policy The Medical Director
Responsibilities of the Squad Responsibilities of each EMT-B Now
let us take a look at New Jerseys Epinephrine Auto Injector
Policy
Slide 12
ASSIST The medication must be prescribed to the patient The
medication must be prescribed to the patient The patient carries
the medication with him The patient carries the medication with him
National EMT-B Curriculum allows EMTs to ASSIST a patient with
EpiPen National EMT-B Curriculum allows EMTs to ASSIST a patient
with EpiPen The OEMS Policy allows EMTs to ADMINISTER an EpiPen to
the patient The OEMS Policy allows EMTs to ADMINISTER an EpiPen to
the patient DEFINITIONS ADMINISTER The medication will be
prescribed to the squad The medication will be prescribed to the
squad The medication is carried on the ambulance The medication is
carried on the ambulance In either case the extent to which the
patient or EMT-B participate with the use of the EpiPen can vary
significantly. The EMT-B may just watch patient use the EpiPen or
the EMT-B may actually perform the stick.
Slide 13
NJ Epinephrine Auto Injector Policy The National Standard
Curriculum for EMT-B provides that EMT-Basics are trained to
recognize clinical signs and symptoms of anaphylactic shock and
establishes that it is within the scope of practice of the
EMT-Basic to assist a patient in the self-administration of a
patient's Epinephrine Auto Injector
Slide 14
NJ Epinephrine Auto Injector Policy PL 2003, c,1., N.J.S.A.
26:2K-47.1, presently authorizes OEMS to certify the NJ EMT-B to
administer the epinephrine auto injector to patients suffering from
anaphylactic shock PL 2003, c,1., N.J.S.A. 26:2K-47.1, presently
authorizes OEMS to certify the NJ EMT-B to administer the
epinephrine auto injector to patients suffering from anaphylactic
shock NJ OEMS recognizes that the expeditious implementation of
this law would have an immediate benefit to the general public NJ
OEMS recognizes that the expeditious implementation of this law
would have an immediate benefit to the general public Accordingly,
OEMS shall now authorize the NJ certified EMT-B to administer the
epinephrine auto injector to patients in accordance with the
following policies and protocols Accordingly, OEMS shall now
authorize the NJ certified EMT-B to administer the epinephrine auto
injector to patients in accordance with the following policies and
protocols
Slide 15
NJ Epinephrine Auto Injector Policy The EMT-B is allowed to
administer an Epinephrine Auto Injector to prehospital patients
only before an ALS Unit arrives The EMT-B is allowed to administer
an Epinephrine Auto Injector to prehospital patients only before an
ALS Unit arrives Once the ALS Unit arrives the Paramedics will
administer Epinephrine from their stock Once the ALS Unit arrives
the Paramedics will administer Epinephrine from their stock NJ
Paramedics can administer Epinephrine immediately under Standing
Orders NJ Paramedics can administer Epinephrine immediately under
Standing Orders The Paramedics Medical Control Physician will
provide on line medical control after the Paramedics complete the
Standing Orders The Paramedics Medical Control Physician will
provide on line medical control after the Paramedics complete the
Standing Orders
Slide 16
NJ Epinephrine Auto Injector Policy Only EMT-Basics meeting the
following requirements are authorized by OEMS to carry on their
ambulance and administer epinephrine auto injectors to patients
Only EMT-Basics meeting the following requirements are authorized
by OEMS to carry on their ambulance and administer epinephrine auto
injectors to patients Only EMT-Basics acting with the general
authority of a physician medical director, will be allowed to
administer epinephrine auto injectors to prehospital patients Only
EMT-Basics acting with the general authority of a physician medical
director, will be allowed to administer epinephrine auto injectors
to prehospital patients BLS agencies must complete an approved
training program prior to obtaining or using epinephrine auto
injectors BLS agencies must complete an approved training program
prior to obtaining or using epinephrine auto injectors
Slide 17
NJ Epinephrine Auto Injector Policy Only EMT -Basics who are
members of BLS agencies that are registered with NJ OEMS may
possess or administer the Epinephrine Auto Injector to patients
Only EMT -Basics who are members of BLS agencies that are
registered with NJ OEMS may possess or administer the Epinephrine
Auto Injector to patients OEMS will monitor the EMT-B use of
epinephrine auto injectors according to these policies and will
take corrective action as is deemed necessary for the safe
implementation of this policy OEMS will monitor the EMT-B use of
epinephrine auto injectors according to these policies and will
take corrective action as is deemed necessary for the safe
implementation of this policy
Slide 18
Medical Director DR. MICHAEL MARCHETTI Provides Off-line
Medical Control Provides Off-line Medical Control Will provide the
prescriptions for the Epinephrine Auto Injectors Will provide the
prescriptions for the Epinephrine Auto Injectors Responsible for
all clinical aspects of the MONOC EpiPen Program Responsible for
all clinical aspects of the MONOC EpiPen Program Training and
Quality Assurance Training and Quality Assurance
Slide 19
The First Aid Squad Register with OEMS Register with OEMS
Contract with MONOC Contract with MONOC Initial training at FAS
location Initial training at FAS location Fill Medical Directors
prescription for the Epinephrine Auto Injector Fill Medical
Directors prescription for the Epinephrine Auto Injector Stock the
squads ambulances with the Epinephrine Auto Injector and a sharps
disposal container Stock the squads ambulances with the Epinephrine
Auto Injector and a sharps disposal container
Slide 20
The First Aid Squad Send new EMT-B certified members to the
regional Initial MONOC training programs Send new EMT-B certified
members to the regional Initial MONOC training programs Epinephrine
Auto Injector administered by EMT-Bs certified as per OEMS Policy
only Epinephrine Auto Injector administered by EMT-Bs certified as
per OEMS Policy only Proper disposal and replacement of used or
expired Epinephrine Auto Injectors Proper disposal and replacement
of used or expired Epinephrine Auto Injectors Send required reports
to MONOC and OEMS upon using an Epinephrine Auto Injector Send
required reports to MONOC and OEMS upon using an Epinephrine Auto
Injector
The EMT-B Attend Initial and Renewal classes Attend Initial and
Renewal classes Sign the MONOC contract to administer the
Epinephrine Auto Injector Sign the MONOC contract to administer the
Epinephrine Auto Injector Maintain Current EMT-B and CPR certs
Maintain Current EMT-B and CPR certs Adhere to all MONOC & OEMS
Policies Adhere to all MONOC & OEMS Policies Submit required
reports to MONOC and OEMS on use Epinephrine Auto Injector Submit
required reports to MONOC and OEMS on use Epinephrine Auto
Injector
Slide 23
NJ Epinephrine Auto Injector Law Immunity From Civil Liability
An EMT-B certified to administer epinephrine auto injector pursuant
to this law or officers and members of any first aid, ambulance or
rescue squad shall not be liable for any civil damages as the
result of any act or the any omission of an act committed while in
training to administer, or in the administration of, the
epinephrine auto injector in good faith and in accordance with the
provisions of this law
Slide 24
Progression of Allergic Reaction Myths & Reality
Anaphylaxis Fatalities Common Causes of Anaphylaxis Now let us take
a look at Pathogenesis of Anaphylaxis
Slide 25
Anaphylaxis is underreported Anaphylaxis is underreported
Incidence seems to be increasing Incidence seems to be increasing
Anaphylaxis leads to 200 deaths a year Anaphylaxis leads to 200
deaths a year Up to 41 million Americans at risk Up to 41 million
Americans at risk 63,000 new cases per year 63,000 new cases per
year 5% of adults have history of anaphylaxis 5% of adults have
history of anaphylaxis The Reality! Myth: Anaphylaxis Is Rare
Slide 26
Systemic allergic reaction Systemic allergic reaction Affects
body as a whole Multiple organ systems may be involved Onset
generally acute Onset generally acute Manifestations vary from mild
to fatal Manifestations vary from mild to fatal WHAT IS Anaphylaxis
? DEFINITION
Slide 27
Myth: Anaphylaxis is Easy to Avoid If You Know What You are
Allergic To REALITY: Most cases of Anaphylaxis are Accidental
Exposures Accidental Exposures Immediate Treatment = Saved Lives =
Saved Lives
Slide 28
Pathogenesis of Anaphylaxis Hypersensitivity Hypersensitivity
Sensitization Stage Sensitization Stage End result is an
anaphylactic response The clock is ticking End result is an
anaphylactic response The clock is ticking Immediate Treatment =
Saved Lives
Slide 29
Pathogenesis of Anaphylaxis Antigen (allergen) exposure Antigen
Antigen: A substance that is capable of causing the production of
an antibody Antigen: A substance that is capable of causing the
production of an antibody Antigens may or may not lead to an
allergic reaction Antigens may or may not lead to an allergic
reaction Allergens: Antigens that cause an allergic reaction and
the production of a substance called IgE Allergens: Antigens that
cause an allergic reaction and the production of a substance called
IgE
Slide 30
Pathogenesis of Anaphylaxis Antigen (allergen) exposure Antigen
Allergic Reactions Dont Occur at First Exposure to Allergen First
Exposure First Exposure Immune system sees substance as allergic
trigger or ALLERGEN and attempts to protect the body from that
specific allergen by creating specific chemicals called ANTIBODIES
Later Exposure with that same Allergen Later Exposure with that
same Allergen On subsequent exposures to same allergen, the
antibodies attack & engage the invading allergens to produce
the allergic response
Slide 31
Pathogenesis of Anaphylaxis Plasma cells produce IgE antibodies
against the allergen Plasma Cell Immunoglobulin: A protein produced
by plasma cells Immunoglobulin: A protein produced by plasma cells
IgE: A class of immunoglobulins (Ig) that includes the antibodies
elicited by an allergic substance (allergen) IgE: A class of
immunoglobulins (Ig) that includes the antibodies elicited by an
allergic substance (allergen) A person who has an allergy usually
has elevated blood levels of IgE antibodies that will attack and
engage the invading army of allergens A person who has an allergy
usually has elevated blood levels of IgE antibodies that will
attack and engage the invading army of allergens
Slide 32
Pathogenesis of Anaphylaxis IgE antibodies attach to mast cells
and basophils Mast cell: A connective tissue cell whose normal
function is unknown but which is frequently injured in allergic
reactions, releasing chemicals including histamine that are very
irritating and cause itching, swelling, and fluid leakage from
cells Mast cell: A connective tissue cell whose normal function is
unknown but which is frequently injured in allergic reactions,
releasing chemicals including histamine that are very irritating
and cause itching, swelling, and fluid leakage from cells Basophil:
A type of white blood cell with coarse bluish-black granules of
uniform size within the cytoplasm. Basophils are so named because
their cytoplasmic granules stain with basic dyes. Basophils contain
and can release histamine Basophil: A type of white blood cell with
coarse bluish-black granules of uniform size within the cytoplasm.
Basophils are so named because their cytoplasmic granules stain
with basic dyes. Basophils contain and can release histamine Mast
cell with fixed IgE antibodies Granules that contain histamine
Slide 33
Pathogenesis of Anaphylaxis IgE antibodies attach to mast cells
and basophils Basophils contain and can release histamine Basophils
contain and can release histamine Histamine: A substance that plays
a major role in many allergic reactions. Histamine dilates blood
vessels and makes the vessel walls abnormally permeable. This will
result in systemic swelling. Histamine: A substance that plays a
major role in many allergic reactions. Histamine dilates blood
vessels and makes the vessel walls abnormally permeable. This will
result in systemic swelling. Mast cell with fixed IgE antibodies
Granules that contain histamine
Slide 34
HISTAMINES Symptoms progress FAST! Symptoms progress FAST!
These actions cause fluid loss These actions cause fluid loss
Swelling Hypotension VASODILATION PERMEABILITY
Slide 35
Anaphylactic Reaction More of same allergen invades body
Antigen Mast cell granules releases contents after the antigen
binds with IgE antibodies Histamine and other mediators. Allergen
combines with IgE attached to mast cells and basophils, which will
trigger degranulation and release of histamine and other chemical
mediators IMMEDIATE TREATMENT = SAVED LIVES A Systemic allergic
reaction - Affects body as a wholeA Systemic allergic reaction -
Affects body as a whole
Signs & Symptoms of Anaphylaxis Myths & Reality Food -
Venom Latex Other Conditions Mimic Anaphylaxis Now let us take a
look at Clinical Presentation Anaphylaxis
Slide 40
Clinical Presentation of Anaphylaxis Immediate Treatment =
Saved Lives
Slide 41
Severe Allergic Reaction Immediate Treatment = Saved Lives
HIVES are also known medically as URTICARIA URTICARIA
Slide 42
Myth: Anaphylaxis Always Presents with Hives REALITY:
Approximately 10%-20% of all anaphylaxis cases will not present
with any hives or other cutaneous manifestations Approximately
10%-20% of all anaphylaxis cases will not present with any hives or
other cutaneous manifestations 80% of food-induced, fatal
anaphylaxis cases were not associated with any cutaneous signs or
symptoms 80% of food-induced, fatal anaphylaxis cases were not
associated with any cutaneous signs or symptoms
Slide 43
Myth: The Cause of Anaphylaxis is Always Obvious REALITY:
Idiopathic anaphylaxis is common Triggers may be hiddenTriggers may
be hidden Foods Latex Patient may not recall details of
exposurePatient may not recall details of exposure
Slide 44
Clinical Presentation of Anaphylaxis Cardiovascular System:
Cardiovascular System: Tachycardia or Bradycardia Hypotension
Arrhythmias Chest Pain (Only 6% of the time) Immediate Treatment =
Saved Lives
Slide 45
Clinical Presentation of Anaphylaxis Respiratory System:
Respiratory System: Shortness of Breath Throat Tightness Tongue
Swelling Wheezing or Stridor Immediate Treatment = Saved Lives
Slide 46
Clinical Presentation of Anaphylaxis Signs &
SymptomsIncidence (%) Urticaria and swelling Upper airway edema
Dyspnea and wheezing Flushed skin Dizziness, syncope, and
hypotension Gastrointestinal symptoms Rhinitis Headache Substernal
chest pain Itch without rash Seizure 88 56 47 46 33 30 16 15 6 4.5
1.5
Slide 47
Clinical Presentation of Anaphylaxis Hives 88% of the time
Swelling of the Tongue 56% of the time These Sx RARELY present with
any other conditions
Slide 48
Conditions That Can Mimic Anaphylaxis Foreign Body Airway
Obstruction Foreign Body Airway Obstruction Wheezing or Stridor
from Other Etiology Wheezing or Stridor from Other Etiology Other
Respiratory Impairments Other Respiratory Impairments Acute MI
Acute MI CHF CHF Asthma Asthma
Slide 49
Conditions That Can Mimic Anaphylaxis ANAPHYLAXISFBAOHives
>88 % of the time NO HIVES Tongue Swollen >50 % of the time
NOT PRESENT Prior Episodes May Have Had Hx Usually NONE Progression
WITHOUT ANY INTERVENTION Symptoms progress increased SOB Reflexes
relax & often lead to reduced Sx Breath Sounds 47% Bilateral
Wheeze 65% Unilateral BS History - Events Leading Up to Episode?
Foreign Body Airway Obstruction
Slide 50
Conditions That Can Mimic Anaphylaxis ANAPHYLAXIS Wheeze -
Stridor Hives >88 % of the time NO HIVES Tongue Swollen >50 %
of the time NOT PRESENT Prior Episodes May Have Had Hx What is
prior Hx? Progression Symptoms progress increased SOB Inhaler or
Humidity often will reduce Sx Breath Sounds >47 % will wheeze
History - Events Leading Up to Episode? Wheezing or Stridor Other
Etiology
Slide 51
Conditions That Can Mimic Anaphylaxis ANAPHYLAXIS Other Resp
Prob Hives >88 % of the time NO HIVES Tongue Swollen >50 % of
the time NOT PRESENT Prior Episodes May Have Had Hx What is prior
Hx? Progression Symptoms progress increased SOB OXYGEN often will
reduce Sx Breath Sounds >47 % will wheeze Rales or Rhonchi? Look
at the patients Meds & Prior History Other Respiratory
Impairments Other Respiratory Impairments
Slide 52
Conditions That Can Mimic Anaphylaxis ANAPHYLAXIS Other Resp
Prob Hives >88 % of the time NO HIVES Tongue Swollen >50 % of
the time NOT PRESENT Substernal Chest Pain Only 6% of the time
>70 % of the time Pain Radiates NOOFTEN ArrythmiasRAREOFTEN Look
at the patients Meds & Prior History Acute MI
Slide 53
Conditions That Can Mimic Anaphylaxis Acute MI Chest Pain in
>70% of MIs Only 6% of Anaphylaxis
Slide 54
Conditions That Can Mimic Anaphylaxis ANAPHYLAXIS Other Resp
Prob Hives >88 % of the time NO HIVES Tongue Swollen >50 % of
the time NOT PRESENT Breath Sounds >47 % will wheeze Rales
(Wheeze early) Blood Pressure 33 % with BP Very High (Drops late)
Pedal edema - + JVD Frothy Pink Sputum NOOFTEN History Orthopnia
Sleeping Position (# of Pillows?) CHF
Slide 55
Conditions That Can Mimic Anaphylaxis CHF CHF Occurs Primarily
in the Geriatric Population
Slide 56
Conditions That Can Mimic Anaphylaxis ANAPHYLAXISASTHMAHives
>88 % of the time NO HIVES Tongue Swollen >50 % of the time
NOT PRESENT Breath Sounds 50% will not wheeze Wheeze (Absent Late)
Progression Only Epi Reduces Sx ! Inhaler or Humidity often will
reduce Sx Area Effected Upper Airway Lower Airway Many Patients
will also have History of Both Anaphylaxis and Asthma ASTHMA
Slide 57
ASTHMA This drawing shows a normal, relaxed airway and air sacs
in the lungs By contrast, this drawing shows tightened airway and
inflamed air sacs in the lungs
Slide 58
Myth: Prior Episodes Predict Future Reactions REALITY: No
predictable pattern No predictable pattern Severity depends on:
Severity depends on: Sensitivity of the individual Dose of the
allergen
Slide 59
Anaphylaxis: Food Induced Food allergies are usually due to the
protein component of the offending food Food allergies are usually
due to the protein component of the offending food For some reason
some of the food protein is absorbed from the intestine intact,
instead of being digested as most proteins are For some reason some
of the food protein is absorbed from the intestine intact, instead
of being digested as most proteins are Once the intact protein is
in the blood stream, it is recognized as a foreign protein to the
body, or in other words as an ANTIGEN Once the intact protein is in
the blood stream, it is recognized as a foreign protein to the
body, or in other words as an ANTIGEN
Slide 60
35%55% of anaphylaxis is caused by food allergy 35%55% of
anaphylaxis is caused by food allergy 6%8% of children have food
allergy 6%8% of children have food allergy 1%2% of adults have food
allergy 1%2% of adults have food allergy Incidence is increasing
Incidence is increasing Accidental exposures are common and
unpredictable Accidental exposures are common and unpredictable
Anaphylaxis: Food Induced Immediate Treatment = Saved Lives
Slide 61
Food Induced Anaphylaxis: Common Triggers
Slide 62
Food-induced Anaphylaxis: Common Symptoms Oropharynx: Swelling
of lips and tongue, throat tightening, slurred speech Oropharynx:
Swelling of lips and tongue, throat tightening, slurred speech GI:
Cramps, diarrhea, nausea, vomiting GI: Cramps, diarrhea, nausea,
vomiting Cutaneous: Urticaria, angioedema Cutaneous: Urticaria,
angioedema Respiratory: Shortness of breath, cough, wheezing or
stridor Respiratory: Shortness of breath, cough, wheezing or
stridor
Slide 63
Anaphylaxis: Venom-induced Common Culprits (Triggers) 13
million Americans are sensitive to insect venoms Culprit Bees Wasps
Hornets Yellow jackets Geographical Honeybees and yellow jackets
most common in East, Midwest, and West regions of US Wasps, fire
ants common in Southwest & Gulf Coast Culprit Fire ants Marine
life Spiders
Slide 64
Venom-induced Reactions: Common Symptoms Normal: Local pain,
Redness, Mild swelling Normal: Local pain, Redness, Mild swelling
Large local: Extended swelling, Redness Large local: Extended
swelling, Redness Anaphylaxis: Usual onset within 1520 minutes
Anaphylaxis: Usual onset within 1520 minutes Cutaneous: Urticaria,
Flushing, Edema Respiratory: Dyspnea, Wheeze or Stridor
Cardiovascular: Dizziness, Loss of Consciousness, Tachycardia or
Bradycardia (late), Hypotension, 30%60% of patients have a systemic
reaction with multiple stings
Slide 65
Anaphylaxis: Latex 1%6% of Americans (> 16 million) affected
1%6% of Americans (> 16 million) affected 8%17% incidence with
health care workers 8%17% incidence with health care workers
Repeated exposure leads to a higher risk Repeated exposure leads to
a higher risk Incidence has increased since mid 1980s Incidence has
increased since mid 1980s Proteins in natural rubber latex Proteins
in natural rubber latex Component of ~40,000 commonly used items
Component of ~40,000 commonly used items Latex Gloves
Slide 66
Anaphylaxis: Latex The sudden, large-scale increase in latex
glove use by healthcare workers since the 1980s lies at the heart
of the growing problem of latex allergy The sudden, large-scale
increase in latex glove use by healthcare workers since the 1980s
lies at the heart of the growing problem of latex allergy As health
care workers protect themselves from AIDS and other bloodborne
diseases, latex glove use became virtually universal in hospitals
As health care workers protect themselves from AIDS and other
bloodborne diseases, latex glove use became virtually universal in
hospitals Healthcare workers, were exposed to more latex than ever
- many have become sensitized to it Healthcare workers, were
exposed to more latex than ever - many have become sensitized to it
Latex Gloves
Latex Anaphylaxis: Prevention Use latex-free products Use
latex-free products Alert employer/health care providers, schools
about need for latex-free products and equipment Alert
employer/health care providers, schools about need for latex-free
products and equipment Wear MedicAlert bracelet Wear MedicAlert
bracelet Awareness of cross-sensitivity with foods: Awareness of
cross-sensitivity with foods: AVOIDANCE Banana Avocado Chestnuts
Kiwi Stone fruit Others
Slide 69
Other Causes of Anaphylactic Reactions Antibiotics Antibiotics
Chemotherapeutic agents Chemotherapeutic agents Aspirin Aspirin
Biologicals (vaccines) Biologicals (vaccines) Radiocontrast media
(IV Dye) Radiocontrast media (IV Dye)
Slide 70
Epinephrine Epinephrine Auto Injector Maintaining the Auto
Injector EPI Auto Injector Administration Now let us take a look at
The Treatment of Anaphylaxis
Slide 71
Treatment of Anaphylaxis Immediate Treatment with Epinephrine
Imperative No contraindications in Anaphylaxis Failure or delay =
Fatalities Must be available at all times Immediate Treatment =
Saved Lives
Slide 72
Epinephrine Auto Injector A Lifesaving Tool Now In the Hands of
the EMT-B Immediate Treatment = Saved Lives = Saved Lives
Slide 73
What Is Epinephrine ? EPINEPHRINE = ADRENALINE Adrenaline is a
natural hormone released in response to stress Adrenaline is a
natural hormone released in response to stress It is a natural
"antidote" to the chemicals released with severe allergic reactions
triggered by a drug, food, or insect allergy It is a natural
"antidote" to the chemicals released with severe allergic reactions
triggered by a drug, food, or insect allergy It is destroyed by
enzymes in the stomach, so must be injected It is destroyed by
enzymes in the stomach, so must be injected When injected, it
rapidly reverses the effects of a severe allergic reaction When
injected, it rapidly reverses the effects of a severe allergic
reaction
Slide 74
CLINICAL PHARMACOLOGY EPINEPHRINE = ADRENALINE Strong
vasoconstrictor action Strong vasoconstrictor action Acts quickly
to counteract both vasodilation and increased vascular permeability
which can lead to loss of volume and hypotension Anaphylaxis
Epinephrine causes smooth muscle relaxation of the bronchial walls
in the airway Epinephrine causes smooth muscle relaxation of the
bronchial walls in the airway air flow alleviates wheezing &
dyspnea Epinephrine is a sympathomimetic drug Epinephrine is a
sympathomimetic drug Heart beats stronger and faster = more
effective
Slide 75
Side Effects ? EPINEPHRINE = ADRENALINE Side effects of
epinephrine may include palpitations, tachycardia, apprehension,
sweating, nausea and vomiting, pallor, respiratory difficulty,
tremor, headache, dizziness, weakness, and nervousness Side effects
of epinephrine may include palpitations, tachycardia, apprehension,
sweating, nausea and vomiting, pallor, respiratory difficulty,
tremor, headache, dizziness, weakness, and nervousness Cardiac
arrhythmias may occur after the administration of epinephrine
Cardiac arrhythmias may occur after the administration of
epinephrine
Slide 76
Risks of anaphylaxis far outweigh risks of epinephrine
administration Risks of anaphylaxis far outweigh risks of
epinephrine administration Minimal cardiovascular effects in
children (Simons et al, 1998) Minimal cardiovascular effects in
children (Simons et al, 1998) Use caution when administering
epinephrine in elderly patients or those with known cardiac disease
Use caution when administering epinephrine in elderly patients or
those with known cardiac disease The Reality! Myth: Epinephrine is
Dangerous
Slide 77
THE AUTO INJECTOR Preloaded Unit Dose Spring Loaded Trigger
AUTO INJECTORS ONLY THE EMT-B IS NOT PERMITTED TO USE A SYRINGE THE
EMT-B IS NOT PERMITTED TO USE A SYRINGE X
Slide 78
CANNOT BE USED BY THE EMT-B The First Dose is an AUTO INJECTOR
Second Dose is a SYRINGE TWINJECT CANNOT BE USED BY THE EMT-B AUTO
INJECTORS ONLY AUTO INJECTORS ONLY THE EMT-B IS NOT PERMITTED TO
USE A SYRINGE THE EMT-B IS NOT PERMITTED TO USE A SYRINGEX
Slide 79
The EpiPen Dismantled EpiPen The Spring The Needle The Syringe
How Does It Work ?
Slide 80
Check the expiration date when you get the prescription - You
should be able to obtain an expiration date 12 - 14 months out
Return expired Auto Injectors to Pharmacy Expiration Dates
Expiration Date and Lot Number MONITOR THE EXPIRATION DATES
Slide 81
Expiration Dates Join the Free EpiPenCenter for Anaphylactic
Support! www.epipen.com/epipen_reminder
Slide 82
EpiPenCenter for Anaphylactic Support There is a free
expiration reminder program Register every time you purchase EpiPen
You get reminders before the expiration date Expiration Date and
Lot Number
Slide 83
CHECK FOR CLARITY Improper storage of the Auto Injector can
cause the Epinephrine to oxidize & go bad Improper storage of
the Auto Injector can cause the Epinephrine to oxidize & go bad
Check the Epinephrine periodically through the viewing window - be
sure the solution is clear and colorless Check the Epinephrine
periodically through the viewing window - be sure the solution is
clear and colorless Replace Auto Injector immediately if solution
is found to be clouded Replace Auto Injector immediately if
solution is found to be clouded Storage of EpiPen Clear Window
XX
Slide 84
CHECK FOR CLARITY Epi stable at room temp until expiration date
Epi stable at room temp until expiration date Epinephrine should
not be refrigerated - refrigeration may cause unit to malfunction
Epinephrine should not be refrigerated - refrigeration may cause
unit to malfunction Epi should not be exposed to high heat Epi
should not be exposed to high heat Do not expose the EpiPen to
direct sunlight for prolonged periods of time Do not expose the
EpiPen to direct sunlight for prolonged periods of time Storage of
EpiPen Clear Window XX
Slide 85
How is Epinepherine Given? Intramuscular (IM) Injection A shot
where the needle goes into the muscle to deliver a certain amount
of medicine A shot where the needle goes into the muscle to deliver
a certain amount of medicine The drug is absorbed in the muscle and
the bloodstream then carries it through the body The drug is
absorbed in the muscle and the bloodstream then carries it through
the body IM injections are made into the striated muscle fibers
under the subcutaneous layer of the skin IM injections are made
into the striated muscle fibers under the subcutaneous layer of the
skin
Slide 86
Where Do I Give Epinepherine? VASTUS LATERALIS MUSCLE Forms
part of quadriceps muscle group Forms part of quadriceps muscle
group Located on anteriolateral aspect of thigh Located on
anteriolateral aspect of thigh Used as the site for IM injections
as it is generally thick and well formed in patients of all ages
and is not located close to any major arteries or nerves Used as
the site for IM injections as it is generally thick and well formed
in patients of all ages and is not located close to any major
arteries or nerves This site is readily accessed This site is
readily accessed Middle third of muscle is the injection site
Middle third of muscle is the injection site QUADRICEPS
Slide 87
Where is Epinepherine Given? ANTERIOLATERAL MID THIGH AREA Same
site is used for both Adult and Pediatric The EpiPen should simply
be pushed against the fleshy outer (lateral) portion of the thigh
There is no need for more precise placement Do not attempt an
injection into a vein or the buttocks Do not attempt an injection
into a vein or the buttocks
Slide 88
EpiPen .15 mg.3 mg Use the EpiPen Jr For Patients Under 4 Years
Old OEMS Policy
Slide 89
Epinephrine dosing is based on body weight Epinephrine dosing
is based on body weight The EpiPen Auto Injector (0.3 mg) is for
individuals weighing 66 lbs. or more The EpiPen Auto Injector (0.3
mg) is for individuals weighing 66 lbs. or more The EpiPen Jr Auto
Injector (0.15 mg) is for those individuals weighing between 33 and
66 lbs The EpiPen Jr Auto Injector (0.15 mg) is for those
individuals weighing between 33 and 66 lbs The OEMS Epinephrine
Auto Injector Policy states to use a EpiPen Jr Auto Injector (0.15
mg) for patients Under 4 years of age The OEMS Epinephrine Auto
Injector Policy states to use a EpiPen Jr Auto Injector (0.15 mg)
for patients Under 4 years of age EpiPen.15 mg.3 mg
Slide 90
Determining Weight & Age PEDI - WHEEL BROSELOW SYSTEM Dont
Forget the Obvious ASK THE PARENT !
Slide 91
The Patient Assessment Using the Auto Injector Common Errors
Post Use Now let us take a look at Using the Epinephrine Auto
Injector
Slide 92
Epinephrine Auto Injector How Do I Use It ? AUTO INJECTORS ONLY
AUTO INJECTORS ONLY THE EMT-B IS NOT PERMITTED TO USE A SYRINGE THE
EMT-B IS NOT PERMITTED TO USE A SYRINGEX
Slide 93
Epinephrine Auto Injector EMT CHECKLIST My BLS Agency is
registered with and has been approved by OEMS My BLS Agency is
registered with and has been approved by OEMS I have completed the
mandated training program for Epinephrine Auto Injectors I have
completed the mandated training program for Epinephrine Auto
Injectors I am a current NJ EMT-B I am a current NJ EMT-B I have a
current CPR card I have a current CPR card The patient does not
have his own The patient does not have his own ALS has not yet
arrived on location ALS has not yet arrived on location
Slide 94
Remember Safety First Look Around! Be Alert!
Slide 95
The Scene Size-Up Remember crew safety and BSI! Remember crew
safety and BSI! You already have Off Line Medical Control You
already have Off Line Medical Control Check environment for source
of the reactioninsects, foods, medications Check environment for
source of the reactioninsects, foods, medications Call ALS
immediately Call ALS immediately How many patients? How many
patients? Do you need additional resources? Do you need additional
resources? S T O P L O O K
Slide 96
Initial Assessment As you approach develop a General Impression
As you approach develop a General Impression Assess mental status
Assess mental status Assess A irway Assess A irway Assess the
adequacy of B reathing Assess the adequacy of B reathing Assess C
irculation Assess C irculation Identify patient priority Identify
patient priority
Slide 97
Initial Assessment Identify the patient priority If
unresponsive, then immediately evaluate and treat life threats If
unresponsive, then immediately evaluate and treat life threats ABCs
ABCs Provide 100% oxygen Provide 100% oxygen
Slide 98
Provide 100% OXYGEN Provide 100% oxygen via NRB, but be ready
to assist ventilations if necessary with a BVM High Con O2
Nonrebreather mask @ 10-15 liters per min Nonrebreather mask @
10-15 liters per min 10-15 lpm BVM for Ventilations For inadequate
tidal volume or resp rate For inadequate tidal volume or resp rate
Set @ 15 lpm
Slide 99
General Impression & Chief Complaint Consider the need for
an Epinephrine Auto Injector if any of the following are present:
Generalized urticaria (Present >80% of the time) Swelling of the
face, tongue, or lips Chief Complaint of respiratory distress or
arrest A tightness in the chest and or throat Wheezing or Stridor
Altered mental status Restlessness, Anxiety, Confusion
Restlessness, Anxiety, Confusion Seizure, Unresponsiveness Seizure,
Unresponsiveness
Slide 100
Initial Assessment Look for indications of any circulatory
distressLook for indications of any circulatory distress
Indications of HypoperfusionIndications of Hypoperfusion Rapid
heart rate Cool, moist skin Delayed capillary refill times If
unable to palpate a pulse, then begin CPR and AED resuscitation
immediatelyIf unable to palpate a pulse, then begin CPR and AED
resuscitation immediately
Slide 101
Focused History and Physical Exam Obtain Baseline Vital Signs
Obtain Baseline Vital Signs Look for Medical Alert Tags Look for
Medical Alert Tags Check environment for source of the
reactioninsects, foods, medications Check environment for source of
the reactioninsects, foods, medications Where is the ALS Unit ??
Where is the ALS Unit ?? Responsive patients - SAMPLE HISTORY
Responsive patients - SAMPLE HISTORY Unresponsive patients need to
receive a Rapid Physical Exam Unresponsive patients need to receive
a Rapid Physical Exam Immediate Treatment = Saved Lives
ALLERGY
Slide 102
SHOCK ?? Consider an Epinephrine Auto Injector if any signs or
symptoms of shock are present: CHILD 1 TO 12 years old Heart Rate
> 140 AND/OR BP < 70 Systolic INFANT UNDER 12 months Heart
Rate > 180 AND/OR BP < 60 Systolic ADULT OLDER THAN 12 Heart
Rate > 120 AND/OR BP < 80 Systolic Fast pulses and
hypotension are ominous signs
Slide 103
S A M P L E S Signs and SymptomsS Signs and Symptoms What signs
& symptoms occurred at onset? A AllergiesA Allergies Is patient
allergic to meds, foods, or other? M MedicationsM Medications What
medications is the patient taking? What medications is the patient
taking? P Pertinent Past HistoryP Pertinent Past History Does the
patient have any medical history? L Last Oral IntakeL Last Oral
Intake When & What did patient last eat or drink? E Events
Leading Up ToE Events Leading Up To What events led to this
incident? A S K L I S T E N
Slide 104
Transport Decision GO STAY Transport Promptly Take patient
medications and the Epinephrine Auto Injector with you Treat
respiratory distress and shock, then transport immediately
TRANSPORT
Slide 105
Auscultate Breath Sounds WHEEZING WHEEZING STRIDOR STRIDOR
RALES (CRACKLES) RHONCHI L I S T E N
Slide 106
Focused History and Detailed Physical Exam Consider if:
Consider if: Complaint or history is confusing There is extended
transport time You need to clarify findings In severe Anaphylaxis
reactions the Focused & Detailed Physical exams may be omitted
In severe Anaphylaxis reactions the Focused & Detailed Physical
exams may be omitted Immediate Treatment = Saved Lives
Slide 107
Do I Use the Patients or Mine ? MINE HIS WHAT IF THE PATIENT
HAS HIS OWN EpiPen ? If the patient has a prescribed Epinephrine
Auto Injector then ASSIST the patient with theirs
Slide 108
EpiPen /EpiPen Jr: Directions for Use Storage Tube Remove the
Auto Injector from the Storage Tube Check the Expiration Date &
Color of the Epi
Slide 109
EpiPen /EpiPen Jr: Directions for Use Remove the Safety Cap
AFTER THE SAFETY CAP IS REMOVED KEEP YOUR FINGERS AWAY FROM THE END
The device is now LOADED X
Slide 110
EpiPen /EpiPen Jr: Directions for Use Insert in the Lateral Mid
Thigh Place auto injector firmly against lateral portion of the
thigh, midway between the waist and the knee Place auto injector
firmly against lateral portion of the thigh, midway between the
waist and the knee Firm pressure activates spring mechanism in the
auto injector and forces the needle into the thigh muscles Firm
pressure activates spring mechanism in the auto injector and forces
the needle into the thigh muscles
Slide 111
EpiPen /EpiPen Jr: Directions for Use Hold in place for 10-15
seconds while the epi is injected in muscle Hold in place for 10-15
seconds while the epi is injected in muscle Remove auto injector
from the thigh - careful the needle will now be projecting Remove
auto injector from the thigh - careful the needle will now be
projecting Massage the injection site this will enhance absorption
of the epi Massage the injection site this will enhance absorption
of the epi Hold For 10 Seconds and Remove
Slide 112
COMMON ERRORS MISTAKE NUMBER 1 The black tip contains the
needle and needs to be placed against the mid-thigh. The black tip
contains the needle and needs to be placed against the mid-thigh.
Holding the wrong end and injecting the thumb (blue line) is
painful and not very effective... Holding the wrong end and
injecting the thumb (blue line) is painful and not very
effective...
Slide 113
COMMON ERRORS MISTAKE NUMBER 2 Unless the safety cap is removed
(blue line), the EpiPen will NOT work, no matter how hard you
push... Unless the safety cap is removed (blue line), the EpiPen
will NOT work, no matter how hard you push...
Slide 114
COMMON ERRORS MISTAKE NUMBER 3 This photograph is more subtle.
The patient is pressing the white end very hard (blue line),
assuming there is a "button" at the white end. There is not! This
photograph is more subtle. The patient is pressing the white end
very hard (blue line), assuming there is a "button" at the white
end. There is not!
Slide 115
EpiPen /EpiPen Jr: Directions for Use Place the used Auto
Injector in a sharps container for Safety Place the used Auto
Injector in a sharps container for Safety Note: Most of the liquid
(about 90%) stays in the auto-injector and cannot be reused - The
correct epinephrine dose was given if the RED FLAG appears in clear
window Note: Most of the liquid (about 90%) stays in the
auto-injector and cannot be reused - The correct epinephrine dose
was given if the RED FLAG appears in clear window Needle is Exposed
BE CAREFUL ! Clear Window
Slide 116
The Ongoing Assessment You should have already initiated your
patient TRANSPORT to the hospital DO NOT DELAY You should have
already initiated your patient TRANSPORT to the hospital DO NOT
DELAY Take the Epinephrine Auto Injector with you Take the
Epinephrine Auto Injector with you Where is ALS ? Consider meeting
the ALS unit Line of Sight en route to the hospital Where is ALS ?
Consider meeting the ALS unit Line of Sight en route to the
hospital Notify Receiving Hospital (If NO ALS) Notify Receiving
Hospital (If NO ALS) Immediate Treatment = Saved Lives
TRANSPORT
Slide 117
The Ongoing Assessment Monitor with Vigilance Level of
Distress, Level of Consciousness, Blood Pressure, Respirations,
Pulse, Breath Sounds Monitor with Vigilance Level of Distress,
Level of Consciousness, Blood Pressure, Respirations, Pulse, Breath
Sounds Repeat a second Epinephrine dose if the signs and symptoms
still persist after 10-15 minutes Repeat a second Epinephrine dose
if the signs and symptoms still persist after 10-15 minutes
Maintain Normal Body Temp Maintain Normal Body Temp Where is the
ALS unit? Where is the ALS unit? Immediate Treatment = Saved Lives
TRANSPORT
Slide 118
Biphasic Reactions Immediate Treatment = Saved Lives TRANSPORT
Biphasic reactions - Sx occur again after the initial anaphylaxis
Sx have completely resolved Biphasic reactions - Sx occur again
after the initial anaphylaxis Sx have completely resolved Biphasic
reactions can occur several hours after the initial Anaphylactic
episode Biphasic reactions can occur several hours after the
initial Anaphylactic episode Biphasic reactions happen in up to 20%
of cases Biphasic reactions happen in up to 20% of cases Biphasic
reactions are treacherous more difficult to treat than initial
episode Biphasic reactions are treacherous more difficult to treat
than initial episode Patients often require intubation
Slide 119
DOCUMENTATION REQUIRED ON PCR Location of the Injection
SiteLocation of the Injection Site Medication Name and
DoseMedication Name and Dose Time Epi was AdministeredTime Epi was
Administered Vital Signs Pre and Post EpiVital Signs Pre and Post
Epi Any changes in the patients conditionAny changes in the
patients condition Immediate Treatment = Saved Lives
Slide 120
DOCUMENTATION REQUIRED Leave a copy of the Patient Care Report
(PCR) at the hospitalLeave a copy of the Patient Care Report (PCR)
at the hospital Complete the MONOC QA FormComplete the MONOC QA
Form Send a copy of the PCR toSend a copy of the PCR to MONOC
within 7 days after the call OEMS within 45 days after the call
Immediate Treatment = Saved Lives FINISH THE PAPERWORK!
Slide 121
Medical Director DR. MICHAEL MARCHETTI You administered the
Auto Injector under his Off-line Medical Control You administered
the Auto Injector under his Off-line Medical Control Responsible
for all clinical aspects of the MONOC EpiPen Program Responsible
for all clinical aspects of the MONOC EpiPen Program Will review
documentation provided for Quality Assurance purposes Will review
documentation provided for Quality Assurance purposes
Slide 122
Now let us take a look at AHA 2010 Guidelines for CPR and
Emergency Cardiac Care Assessing Ventilations C-A-B Sequence
Quality CPR Interfacing With ALS
Slide 123
Check Responsiveness Tap the patients shoulder ask are you all
right? Tap the patients shoulder ask are you all right? Check for
movement / chest rise and fall. Check for movement / chest rise and
fall. Check for breathing / adequate breathing. Check for breathing
/ adequate breathing.
Slide 124
AGONAL Breathing Occasional gasps = agonal breathing Will soon
lead to cardiac arrest Called Guppie Breathing This is NOT
effective breathing Assess For Effective Breathing
Slide 125
Pulse Check Check the carotid artery for at least 5 seconds and
no longer than 10 seconds to determine presence of a pulse. Check
the carotid artery for at least 5 seconds and no longer than 10
seconds to determine presence of a pulse. If no pulse, perform 5
cycles of compressions and breaths (ratio 30:2) beginning with
chest compressions. If no pulse, perform 5 cycles of compressions
and breaths (ratio 30:2) beginning with chest compressions.
Slide 126
Compress at a rate of at least 100/min. Compress at a rate of
at least 100/min. Ratio of compressions to breaths same for 1
rescuer or 2 rescuers 30:2 Ratio of compressions to breaths same
for 1 rescuer or 2 rescuers 30:2 Each set of 30 compressions should
take 18 seconds or less. Each set of 30 compressions should take 18
seconds or less. Chest Compressions Compress HARD & FAST
Slide 127
Ventilations delivered TOO FAST or with TOO MUCH VOLUME are NOT
beneficial and may even be HARMFUL Deliver just enough volume to
make the chest rise Each breath should be delivered over one second
Each time you ventilate intrathoracic pressure increases and the
flow of blood through the heart and the blood vessels in chest
decreases Avoid the Urge To Ventilate TOO FAST or TOO HARD!
Ventilate TOO FAST or TOO HARD! Ventilations This is much too
FAST
Slide 128
Rate of Ventilations Child or Infant in respiratory arrest with
a pulse: Deliver 12 - 20 effective breaths per minute Resist the
urge to ventilate faster or harder! This is much too FAST Adult
patient in respiratory arrest with a pulse: Deliver about 10 - 12
breaths per minute Give just enough volume to allow the chest to
rise Resist the urge to ventilate faster or harder! Each rescue
breath should be delivered over one second
Slide 129
A Word About Advanced Airways Once the ET is in place ventilate
at: 8 times per minute Once every 7 seconds DO NOT PAUSE your
cardiac compressions to give breaths DO NOT PAUSE your cardiac
compressions to give breaths This will optimize blood flow This
will optimize blood flow When ALS arrives on scene the paramedics
will secure the airway with an Endotracheal Tube 211 MICU
Slide 130
AGE GROUP Breaths Per Min ADULT 10 per min CHILD 15 per min
INFANT 20 per min ADULT with ET 8 per min Delivery of Ventilations
Each rescue breath should be delivered over one second
Slide 131
AIRWAY EQUIPMENT Provide 100% oxygen via NRB, but be ready to
assist ventilations if necessary with a BVM High Con O2
Nonrebreather mask @ 10-15 liters per min Nonrebreather mask @
10-15 liters per min 10-15 lpm BVM for Ventilations For inadequate
tidal volume or resp rate For inadequate tidal volume or resp rate
Set @ 15 lpm
Slide 132
Best Use of the BVM 2 Rescuer Bag Valve Mask Technique is
Preferred Minimizes the chance of the 2 most common BVM errors -
Poor Seal Loss of Volume - Squeezing bag inadequately One rescuer
seals the mask and opens the airway with an E C clamp The second
rescuer squeezes the BVM with both hands - for good tidal volume
(chest rise) Note the PADDING Note the E C Clamp
Slide 133
Best Use of the BVM 2 Rescuer Bag Valve Mask Technique is
Preferred Sellick Maneuver is done by a third rescuer with
ventilations of an unprotected airway BLS can provide the Sellick
Maneuver early & continually until a ET tube is inserted by the
Paramedics Note the padding under the head for this adult patient
What if this were a child or infant? Note the PADDING Note the E C
Clamp
Slide 134
The Sellick Maneuver The routine use of the Sellick Maneuver is
no longer recommended for use American Heart Association
Slide 135
The Sellick Maneuver BLS Providers can help with the Sellick
Maneuver Used to help line up the airway structures in ET
intubation will help to visualize the vocal cords Used to help line
up the airway structures in ET intubation will help to visualize
the vocal cords Also will help to prevent gastric distension and
vomiting as you ventilate an unprotected airway Also will help to
prevent gastric distension and vomiting as you ventilate an
unprotected airway
Slide 136
The Sellick Maneuver BLS Providers can help with the Sellick
Maneuver Performed by applying gentle pressure to the anterior neck
at the Cricoid Cartilage Performed by applying gentle pressure to
the anterior neck at the Cricoid Cartilage BLS can provide this
maneuver early and continually until an ET tube is inserted BLS can
provide this maneuver early and continually until an ET tube is
inserted
Slide 137
PEDI AIRWAY EQUIPMENT Variety of Sizes OPA OPA BVM BVM BROSELOW
SYSTEM All BLS Ambulances must have airway adjuncts all age groups
of patients of all types available for all age groups of
patients
Slide 138
SUCTION EQUIPMENT Suction Equip READY TO USE READY TO USE Rigid
tip catheter Rigid tip catheter 15 seconds 15 seconds On Board
Equip Oxygen Oxygen Suction Suction Suction should be set up READY
FOR USE BLS Ambulances must have SUCTION available for all patients
Suction should be set up READY FOR USE
Slide 139
2010 Guidelines Focus on Maintaining CPP Maximizing delivery of
quality compressions Minimizing the delivery of ventilations and
other hands off time Coronary Perfusion Pressure (CPP) HIGH QUALITY
CPR SAVES LIVES
Slide 140
The Need for The Need for Quality CPR Maintain compression rate
at - least This rate is same in all AHA age groups - for both one
and multiple rescuers PUSH HARD PUSH FAST MAKE EVERY COMPRESSION
COUNT! Every compression done improperly decreases CPP Per
Minute
Slide 141
All rescuers acting alone should deliver Compressions to
Ventilations Compressions to Ventilations for all victims except
newborns Adequate blood flow is needed to provide delivery of
oxygen to the vital organs Adequate blood flow is needed to provide
delivery of oxygen to the vital organs Scientific studies measured
blood flow to the heart muscle in the coronary arteries Scientific
studies measured blood flow to the heart muscle in the coronary
arteries Coronary Perfusion Pressure (CPP) Coronary Perfusion
Pressure (CPP) A Major Change -
Slide 142
Coronary Perfusion Pressure and the CPR Cycle first 5 - 10
compressions Scientific data shows that CPP builds up to the
maximum with the first 5 - 10 compressions of the CPR cycle CPP
will be maintained by well delivered uninterrupted cardiac
compressions When cardiac compressions are interrupted CPP falls to
almost zero immediately It will then take the next several
compressions to build the CPP back up to the optimal level again
MINIMIZE INTERRUPTIONS
Slide 143
Coronary Perfusion Pressure Over a CPR Cycle PUSH HARD PUSH
FAST Per Minute
Hand Position AGE GROUP Place Your Hands ADULT Center of chest
between nipples 2 hands - Heel of hand on chest other on top CHILD
Center of chest between nipples 1 hand - Heel of one hand on chest
INFANT One Rescuer Just below nipple line 1 Rescuer 2 Fingers
INFANT Multiple Rescuers Just below nipple line 2 Rescuers 2 Thumbs
NO LANDMARKING Eyeball the correct spot and place your hands
Minimize Hands Off Time
Slide 146
Two Thumb Compression Technique For Multiple Rescuer Infant CPR
Encircle the infants chest with both hands Encircle the infants
chest with both hands Spread your 4 fingers across the thorax and
place your 2 thumbs together on the lower half of the sternum
Spread your 4 fingers across the thorax and place your 2 thumbs
together on the lower half of the sternum Note the PADDING
Slide 147
Two Thumb Compression Technique For Multiple Rescuer Infant CPR
Squeeze the thorax with your 4 fingers as you compress over sternum
with your 2 thumbs Squeeze the thorax with your 4 fingers as you
compress over sternum with your 2 thumbs Second rescuer provides
ventilations (15:2 Ratio) Second rescuer provides ventilations
(15:2 Ratio) This technique has been proven to achieve higher CPP
in studies This technique has been proven to achieve higher CPP in
studies Note the PADDING
Slide 148
NJ Epinephrine Auto Injector Policy Allows NJ EMT-B to carry
the Epinephrine Auto Injector in the ambulance & administer
under off-line medical control Anaphylaxis Anaphylaxis is a
condition that progresses through several phases very rapidly
Anaphylaxis can be triggered by several things Food, Stings, Latex
most common Other conditions can mimic Anaphylaxis SUMMARY
Slide 149
The EpiPen The EpiPen is a safe easy device that can rapidly
reverse the effects of Anaphylaxis EMT-B should understand the
actions, the side effects, dose, and site to use for EpiPen Using
the Epi-Pen The EMT-B needs to perform an accurate rapid patient
assessment Proper documentation required per policy Transport
should not be delayed SUMMARY
Slide 150
Airway and CPR Skills It is essential the EMT-B delivers proper
ventilations and compressions to all ages The EMT-B must be
proficient in AHA 2010 Quality CPR is an essential skill Conclusion
The Epinephrine Auto Injector is a new lifesaving tool now in the
hands of the EMT IMMEDIATE TREATMENT = SAVED LIVES SUMMARY
Slide 151
Additional Information For Anaphylaxis -- WEB SITES FOR
INFORMATION --
Slide 152
EpiPen Auto Injector A Lifesaving Tool Now In the Hands of the
EMT-B Immediate Treatment = Saved Lives = Saved Lives
Slide 153
Thank You For Your Participation For More CEUs www.MONOC.ORG
Thank You For Your Participation For More CEUs www.MONOC.ORG