EMT OPTIONAL SKILL. Cell Phones and Pagers. Epinephrine Auto-injector. Course Outline 9/2017

Transcription

1 EMT OPTIONAL SKILL Epinephrine Auto-injector Cell Phones and Pagers Be courteous to your classmates! Please set your cell phones and/or pagers to silent or turn them off. Course Outline Introduction and Overview Lecture Break Lecture and Review Break Written Test Break Skills Demonstration and Practice Skills Competency Test and Course Evaluation 1

2 Optional EMT Skills may only be performed while on duty with an approved optional skills BLS provider. Once an SJCEMSA Accredited Paramedic arrives at scene, that Paramedic will provide all further ALS patient care. No EMT Optional Skills will be performed or authorized in the presence of an SJCEMSA Accredited Paramedic. Course Objective Participants should be able to identify patients with suspected anaphylaxis and administer epinephrine by auto-injector as appropriate. 2

3 Medical Control Philosophy Don t rush to do in the field what I won t rush to do in the ED Dr. R. Buys Medical Control Philosophy, cont. Optional skills EMTs in deliver health care according to local policies. He/she is individually responsible for adherence to these standards. Medical Control Two categories: Online Offline 3

4 Offline Medical Control Optional skill EMTs will administer Epinephrine Auto-injector from a standing order per SJCEMSA Policy No. 5551, BLS Allergic Reaction - Anaphylaxis Anaphylaxis Definition Common causes 4

5 Signs and symptoms Severe generalized hives or swelling to face, neck, hands, feet, tongue Respiratory distress Difficulty swallowing Difficulty breathing Hoarseness Stridor Signs and symptoms, cont. Wheezing Tightness in throat or chest Decreased mental status Assessment that reveals shock (hypoperfusion) Objective Findings of Signs & Symptoms Mild hives, rash Moderate - hives, rash, bronchospasm, wheezing Severe - altered mental status, signs of shock, respiratory distress, chest tightness, difficulty swallowing 5

6 Mild, Moderate, or Severe Mild, Moderate, or Severe, cont. Personal Protective Equipment Scene Safety 6

7 SJCEMSA Policy No. 5503, BLS Routine Medical Care SJCEMSA Policy No. 5504, BLS Patient Assessment Primary Survey SJCEMSA Policy No. 5505, BLS Patient Assessment Secondary Survey 7

8 SJCEMSA Policy No. 5520, BLS Respiratory Distress SJCEMSA Policy No. 5551, BLS Allergic Reaction - Anaphylaxis SJCEMSA Policy No. 5552, BLS Bites and Stings 8

9 Profile of Epinephrine Overview Contraindications There are no absolute contraindications to the administration of epinephrine after a potentially life-threatening allergen exposure resulting in anaphylaxis. Side/adverse Effects Increased heart rate Palpitations (the heart is beating too fast, too hard or skipping a beat) Pallor (lack of color) skin signs Sweating Nausea or vomiting Nervousness or anxiety Cardiac arrest 9

10 Route of Administration Intramuscular injection (IM) to the lateral aspect of the thigh. Dosages EpiPen Auto-Injector 0.3mg in 0.3mL EpiPen Jr. Auto-injector 0.15mg in 0.3mL Calculating medication dosages If patient weighs less than 30 Kg (66 pounds) use EpiPen Jr. If patient weighs more than 30 Kg (66 pounds) use EpiPen Tip: The average 10 year old weighs 66 pounds. (50% of kids) A large 7 year old can weigh 66 pounds (5% of kids) A thin 12 year old can weigh 66 pounds (5% of kids) Mechanisms of Medication Action Produces vasoconstriction; Reduces mucosal edema; Down-regulates the release of histamine; Relieves hives, swelling to the tongue and throat, and gastrointestinal symptoms. 10

11 Aseptic Technique Definition: A procedure used by medical staff to prevent the spread of infection. The goal is to reach asepsis, which means an environment that is free of harmful microorganisms. Pre Administration Considerations: Before administering ALWAYS ASK Are you allergic to any medication? Pre Administration Considerations: It is important to remove the allergen from the patient, if possible. To remove a bee sting, brush the surface of the patient s skin with a flat edge (ex. plastic ID card, tongue depressor). The edge of the stinger will catch the edge of the flat surface and be pulled out. Do not squeeze the stinger (using tweezers) as it may squeeze more venom from the sac into the patient. Irrigate the patient if the allergen is a substance on the skin (ex. grass, pollen, dust, poison ivy). This can be accomplished by using a bottle of sterile water, or a hose. 11

12 Remove the stinger Indications Mild Not Indicated Moderate Improving Not Indicated Worsening - Indicated Severe - Indicated Steps of administration 1. Take universal body/substance isolation precautions; 2. Perform scene size-up; 3. Perform primary survey; 4. Decontamination by removing any allergy irritants e.g. bee stingers, latex dust; 12

13 5. Determine if indications for administration of epinephrine auto-injectors are met; 6. Ask the patient if they are allergic to any medications; 7. Check for correct medication, concentration, integrity of container, dosage, and expiration date; 8. Select and prepare injection site using aseptic technique; 9. Remove safety cap from the auto-injector; 10. Place tip of auto-injector against the patient s lateral mid-thigh at a 90 degree angle; 11. Use a quick motion, press hard onto thigh until auto-injector mechanism functions, and hold in place for 10 seconds; 12. Withdraw auto-injector and using a dressing/bandage apply pressure to injection site and massage area for 10 seconds; 13. Dispose of auto-injector in sharps container; 14. Continue monitoring patient and observing for improvement or worsening of the patient s respiratory distress; 13

14 15. Complete secondary survey and provide supplemental oxygen and respiratory support if necessary; 16. Document site of injection, patient response and side effects. Cardiopulmonary Resuscitation (CPR) 30:2 vs. MICR BLS Medical Cardiac Arrest - Adult EMS Policy No On-going Care Continue to support respirations as necessary which may include positive pressure ventilation via bag-valve mask (BVM) and supplemental oxygen; Monitor for signs and symptoms of shock (hypoperfusion); Complete BLS Secondary Survey 14

15 Found Did Have Transfer of Care to Transporting Unit Document Complete your patient care record! Case Scenario Practice Case #1 You respond to a 43 year old female who is found in her kitchen at home. The patient is speaking in full sentences and tells you she was working in her garden when she was stung by a bee on her left forearm. The patient has hives on both arms, her chest and her neck. Upon assessment of vital signs, her blood pressure is 118/82, pulse is 94, and respiratory rate is 18 per minute with slight audible wheezing. The patient tells you that when she started wheezing, she took one (1) dose of her inhaler and 25mg of Benadryl by mouth, prior to EMS arrival. What is the first action you should take? 15

16 Case Scenario Practice Case #1 - Answer The first action to take is to ensure the patient s ABC s and remove the allergen (bee stinger) remember to use a scraping motion to remove the stinger. This patient falls into the Moderate category of objective findings as she has hives and wheezing. Determining if the patient should be administered epinephrine or not is based on the patient s developing condition. If the patient s condition improves, epinephrine is not indicated. If the patient s condition worsens, epinephrine is indicated. Some of the signs and symptoms of a worsening condition could be: Increased wheezing Not being able to speak in full sentences Increased agitation and distress Case Scenario Practice Case #2 You respond to a 19 year old male who is found at a Thai restaurant in the local mall. Upon approaching the patient, you note he is sitting on the edge of his chair, tri-poding; audible wheezing can be heard as you approach. The patient appears agitated, and repeats can t breathe, can t breathe. His lips are swollen and his eyes are puffy. Upon assessment of vital signs, his blood pressure is 88/64, pulse is 122, respiratory rate is 28 per minute and shallow with audible wheezing, and skin signs are flushed, warm and moist. When you ask the patient if he has food allergies, he can only respond by shaking his head yes. What is the first action you should take? Case Scenario Practice Case #2 - Answer The first action to take is to ensure the ABC s, and remove any allergen if possible. Epinephrine administration is immediately indicated. This patient falls into the Severe category of objective findings as he has respiratory distress (wheezing), signs of shock, he is becoming agitated and perhaps altered, and the patient went from speaking 1-2 word sentences to only being able to answer questions by shaking his head yes or no. 16

17 Optional EMT Skills may only be performed while on duty with an approved optional skills BLS provider. Questions? Contact EMS Agency at , if you have any questions or feedback related to this training. 17