2009 paramedic assist

Paramedic AssistParamedic Assist

Presented by Shore Emergency Educators

Presented by Shore Emergency Educators

ObjectivesObjectives

Overview of BLS protocols

BLS►ALS Assistance

Overview of BLS protocols

BLS►ALS Assistance

BLS ProtocolsBLS Protocols

Soon to be updated!!! Yeah!!!!!!!Soon to be updated!!! Yeah!!!!!!!

ProtocolsProtocols

General patient careChest painAcute respiratory distressSevere allergic reactionDiabetics with altered mental statusAutomatic external defibrillatorPediatric and adult traumaPulse OximetryRefusal of serviceGuidelines regarding DNR orders

General patient careChest painAcute respiratory distressSevere allergic reactionDiabetics with altered mental statusAutomatic external defibrillatorPediatric and adult traumaPulse OximetryRefusal of serviceGuidelines regarding DNR orders

General Patient CareGeneral Patient Care

Safety: scene, universal precautions

ABC’s

SAMPLE History

Pertinent physical exam

Oxygen as appropriate

Appropriate transportation

Transfer of care

Safety: scene, universal precautions

ABC’s

SAMPLE History

Pertinent physical exam

Oxygen as appropriate

Appropriate transportation

Transfer of care

Chest PainChest Pain

Non-traumatic

Possible cardiac origin

Follow General Patient Care Protocol

Nitroglycerin Standing Order

Non-traumatic

Possible cardiac origin

Follow General Patient Care Protocol

Nitroglycerin Standing Order

Assist patient with prescribed nitroglycerinAssure BP > 100 systolic prior to each dose!!!Maximum 3 doses3 to 5 minutes apartRecheck blood pressure between doses

VIAGRA or other ED Drugs

Acute Respiratory DistressAcute Respiratory Distress

Signs and Symptoms of acute exacerbations of asthma, emphysema, reactive airway disease, and allergic reactions include:

Cough, shortness of breath and air hunger, wheezing, diminished breath sounds, retractions, and tachypnea.

Signs and Symptoms of acute exacerbations of asthma, emphysema, reactive airway disease, and allergic reactions include:

Cough, shortness of breath and air hunger, wheezing, diminished breath sounds, retractions, and tachypnea.

Acute Respiratory DistressAcute Respiratory Distress

Assist/Administer MDIShort acting

Rescue inhaler

Albuterol, Atrovent, Proventil, Combivent

Assist/Administer MDIShort acting

Rescue inhaler

Albuterol, Atrovent, Proventil, Combivent

Acute Respiratory DistressAcute Respiratory Distress

CPAP—Pilot program

ALS Standard

Different Equipment

Need to perform accurate assessment quickly

CPAP—Pilot program

ALS Standard

Different Equipment

Need to perform accurate assessment quickly

CPAPCPAP

Severe Allergic ReactionSevere Allergic Reaction

Urticaria (hives) with respiratory distress.

Partial or complete airway obstruction

(sensation of throat closing)

Hypotension or evidence of shock.

Urticaria (hives) alone with a history of life threatening allergic reaction

Patients with severe asthma may manifest their allergic reaction primarily as an asthma attack.

Urticaria (hives) with respiratory distress.

Partial or complete airway obstruction

(sensation of throat closing)

Hypotension or evidence of shock.

Urticaria (hives) alone with a history of life threatening allergic reaction

Patients with severe asthma may manifest their allergic reaction primarily as an asthma attack.

Diabetics with Altered Mental StatusDiabetics with Altered Mental Status

Patient should be a known diabetic suffering from an altered mental status.

The cause of the altered mental status could be low blood sugar.

Follow general patient care protocol.

Patient should be a known diabetic suffering from an altered mental status.

The cause of the altered mental status could be low blood sugar.

Follow general patient care protocol.

Diabetics with Altered Mental StatusDiabetics with Altered Mental Status

Be alert for signs of trauma during the physical examination. Patients with altered mental status due to trauma should not be given anything by mouth in case their condition worsens unexpectedly or they require an operation to repair damage.

Be alert for signs of trauma during the physical examination. Patients with altered mental status due to trauma should not be given anything by mouth in case their condition worsens unexpectedly or they require an operation to repair damage.

ALS ProtocolsALS Protocols

All patient care starts the same no matter ALS or BLS.

Patient Assessment

The better BLS assesses the patient if on scene first, the quicker the patient receives care, which is the ultimate goal

All patient care starts the same no matter ALS or BLS.

Patient Assessment

The better BLS assesses the patient if on scene first, the quicker the patient receives care, which is the ultimate goal

Overview of ALS EquipmentOverview of ALS Equipment

You are not responsible to know how to operate ALS equipment, but general knowledge is helpful.

12 Lead EKG Monitor

Never should you administer/assist in any medication that is outside of your scope of practice (protocols).

You are not responsible to know how to operate ALS equipment, but general knowledge is helpful.

12 Lead EKG Monitor

Never should you administer/assist in any medication that is outside of your scope of practice (protocols).

ECG MonitorECG Monitor

ON/OFF

ECG MonitorECG Monitor

12 Lead Button

ECG MonitorECG Monitor

Selector Wheel

ECG MonitorECG Monitor

PRINTERDEFIB CABLES

ECG MonitorECG Monitor

LEAD AND SIZE

NIBP

ECG MonitorECG Monitor

SA02/EtCO2

12 Lead12 Lead

V1-V2- 4TH

V3

V4-5th

V5

V6-6th

V1-V2- 4TH

V3

V4-5th

V5

V6-6th

12 Lead12 Lead

12 Lead12 Lead

12 Lead12 Lead

CPR DevicesCPR Devices

Keep providers seated

Don’t “tire” out

Consistent

Keep providers seated

Don’t “tire” out

Consistent

CPR DevicesCPR Devices

CPR DeviceCPR Device

IV TubingIV Tubing

Trauma TubingTrauma Tubing

Trauma Tubing (cont.)Trauma Tubing (cont.)

HypothermiaHypothermia

Resuscitated Cardiac Arrest

Ice Packs

Cold Fluid

Resuscitated Cardiac Arrest

Ice Packs

Cold Fluid

HypothermiaHypothermia

HypothermiaHypothermia

That’s allThat’s all