Preparatory/Basic Anatomy/Airway Mechanics *** CME Version *** Aaron J. Katz, AEMT-P, CIC

Transcription

1 Preparatory/Basic Anatomy/Airway Mechanics *** CME Version *** Aaron J. Katz, AEMT-P, CIC

2 EMT Roles & Responsibilities Personal Safety! If not safe Have it made safe! Safety of the crew, patient and bystanders *** Patient Assessment *** Patient Care Lifting and Moving

3 EMT Roles & Responsibilities-2 Transport Transfer of care Patient Advocacy Reporting accurately & completely to ER Reporting observed & perceived needs E.g. The need for a social worker

4 Levels of EMT Training CFR EMT-Basic ( EMT-B ) EMT-I EMT-CC ( Level 3 ) not a uniform training level EMT Paramedic ( EMT-P )

5 Chain of Command Medical Director Protocols Rules for assessing and caring for different patient conditions No set of rules will cover all situations Standing Orders ( off-line ) Medical Control Options ( on-line )

6 Medical-Legal Issues Many medical, legal and ethical considerations Issues/Terms you must be familiar with

7 Scope of Practice Set of rules & regulations that allow one to function as an EMT Defined by legislation Set by Article 30 of the Public Health Law Defines what the EMT can and cannot do Varies by state and often by region within state

8 Consent Permission is required from every patient to treat him or her May be withdrawn at any time Expressed Consent Given by adults capable of making a rational decision about their care

9 Consent Implied Consent Assumed consent Assumed that the patient would agree to care Examples: Unconscious patient Medically unstable children

10 Consent Children and Mentally incompetent adults: Require parents or legal guardian If in danger ( unstable ) Treat under the doctrine of implied consent

11 Consent Emancipated Minors Treat as an adult even if they are under age Laws vary Classical examples: Pregnant minor Married person even if technically a minor When the situation changes, they go back to their minor status!

12 Patient Refuses Care Patient may refuse care or withdraw consent Try not to leave a patient who needs care! Be patient Speak with patient & family Alleviate fears Remove obstacles, e.g. Have a neighbor take out the mail Water the plants

13 Patient Refuses Care If all fails, however Patient must be mentally competent Patient must be fully informed of risks of no treatment Patient must sign an RMA Document very carefully! You still may be sued! If it isn t written IT DID NOT HAPPEN!

14 Patient Refuses Care If patient is in danger and refuses care Threaten to call the police Call the police Always follow local protocols of your service

15 DNR Orders Many legal aspects Check local policy Many types of Do Not orders You must see the DNR order! What does a DNR really mean

16 Negligence Failure to act properly Requires proof of all of the following EMT had the duty to act Breach of duty EMT did not provide the standard of care Proximal Cause The action/inaction of the EMT caused the harm Acts of omission Most common cause of lawsuits Acts of commission

17 Duty to Act Who? Paid EMT, on duty, dispatched to a call Questionable cases: EMT not on duty but volunteers at scene Volunteer EMT Paid EMT, on duty but out of coverage area Many laws, vary by locality

18 Abandonment Leaving a patient without assuring that the patient has been turned over to someone of equal or greater training Examples: A paramedic leaves a patient with an EMT when the patient requires paramedic care In a cardiac arrest, an EMT with a defibrillator leaves a patient with an EMT who has no defibrillator training You leave your patient in the ER before they are triaged and your ACR signed

19 Good Samaritan Laws Designed to protect bystanders and volunteers who offer assistance at emergencies Encourage volunteers Will not protect an individual who treats with gross negligence or breaks the law Example Is volunteer EMT covered under the Good Sam laws?

20 Confidentiality All information except: Where a signed release exists To caregivers in the hospital In court Certain abuse cases Be very careful about this!

21 Crime Scenes Keep hands off as much as possible Without compromising patient care Do not disturb evidence Try to work as a team with crime scene staff

22 Basic Anatomy/Airway Mechanics

23 Some Definitions Anatomy Study of human structure Physiology Study of human function Pathophysiology Study of what happens when normal physiology does not work correctly

24 Anatomic Position Person facing forward with palms facing forward Used to provide uniformity in describing the body and its components Examples

25 Terms of Direction Posterior (Dorsal) Anterior (Ventral) Superior Inferior Medial Lateral Proximal Distal Back Front (belly side) Upper part of body Lower part of body Toward the midline Away from the midline Nearer to the body Further from the body

26 Terms of Direction -- 2 Supine Prone Laterally recumbent (Recovery Position) Lying on the back Lying face downward Lying on the side

27 Movements Flexion Extension Abduction Adduction Decrease in angle between 2 bones Increase in angle between 2 bones Movement away from the midline Movement towards the midline

28 Positions Prone Supine Fowler s Position Semi-Fowler s Position Trendelenberg Position Shock Position

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30 Musculoskeletal System Three main functions Shape Protection Movement Divided into two segments Axial Appendicular 206 bones

31 The BIG Head

32 Spinal Column 5 divisions Cervical 7 bones Thoracic 12 bones Lumbar 5 bones Sacrum 5 bones Coccyx 4 bones ( fused ) Tail

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34 Thorax 12 pairs of ribs 10 pairs articulate with sternum 2 lowest pairs are called floating ribs Sternum 3 parts Manubrium Sternal body Xyphoid Process

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36 Pelvis Ilium Large bone containing the iliac crests Ischium Posterior portion Pubis Acetabulum Socket of the hip joint Fractures in the pelvic area are often life threatening

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38 Lower Extremities Femur thigh Largest bone of the body Patella Knee cap Tibia Shin Fibula

39 Lower Extremities -- 2 Malleolus Lateral and medial Tarsals Ankle Metatarsals Foot Phalanges Toes

40 Lower Extremities -- 3 Arteries Femoral Popliteal Posterior tibial Dorsalis Pedis

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42 Upper Extremities Clavicle Most frequently broken bone in the body Scapula Shoulder Girdle Humerus Radius / Ulna Carpals, Metacarpal, Phalanges Arteries Brachial, Radial, Ulnar

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44 Joints Fused Skull Fontanelles Hinged Fingers, Knee Ball and Socket Shoulder Hip

45 Muscles Same function as skeleton Three types of muscles Voluntary Under control of brain via the nervous system Responsible for movement Involuntary Responsible to automatically control GI, GU, Blood Vessel Size, Breathing, Heart Beat

46 Cardiac Muscle Specialized form of involuntary muscle Has the property of automaticity Allows the heart to generate electrical impulse on its own Automaticity and heart disease

47 The Abdomen Divided into four quadrants RUQ Liver, Gallbladder, Colon LUQ Stomach, Spleen, Colon RLQ Appendix, Colon LLQ Colon

48 The Abdomen -- 2 Small Intestine Found in all quadrants Retroperitoneal Organs Pancreas Behind RUQ and LUQ Urinary Bladder Kidneys Behind RLQ and LLQ Above the level of the umbilicus

49 Abdominopelvic Organs Hollow Stomach Small Intestine Appendix Large Intestine (colon) Ureters Urinary Bladder Urethra

50 Abdominopelvic Organs Solid Liver Spleen Kidneys Pancreas

51 Abdominopelvic Organs Reproductive Female Ovaries, Fallopian Tubes, Uterus, Vagina Male Scrotum, Penis All organs are outside of the body cavity

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55 Airway Anatomy Mouth / Nose Oropharynx / Nasopharynx Pharynx Throat

56 Airway Anatomy -- 2 Trachea Tube surrounded by semicircular cartilage giving it shape Top cartilage is the Cricoid Cartilage Totally surrounds the tube Many implications in emergency medicine Ventilation CPR

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58 Airway Anatomy -- 3 Bronchi 3 on the right side 2 on the left side Bronchioles Alveoli One cell thick Oxygen (O 2 ) in Carbon Dioxide (CO 2 ) out O 2 and CO 2 diffuse to/from capillaries to/from alveoli the action is here!

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62 Breathing Mechanics Inhalation an active process CO 2 level in the bloodstream rises Diaphragm and intercostal muscles contract Ribs and lungs move upward and outward Lung capacity increases Causing lower air pressure in the lungs than in the atmosphere and therefore Air rushes into the lungs UNTIL Atmospheric pressure = air pressure in lungs

63 Breathing Mechanics -- 2 Exhalation A passive process Diaphragm and intercostals move upward Ribs and lungs move downward and inward Causing higher air pressure in the lungs than in the atmosphere Air leaves the lungs

64 Breathing Mechanics -- 3 CO 2 level rises The entire process begins again

65 Oxygen Delivery Devices Nasal Cannula Low flow, low percentage 20 44% oxygen NonRebreather Mask High flow, high percentage Up to approximately 80-90% oxygen Bag Valve Mask ( BVM ) High flow, high percentage Close to 100% oxygen Used to ventilate patients with inadequate respirations

66 NonRebreather Mask

67 Nasal Cannula

68 BVM

69 BVM one rescuer

70 BVM two rescuer

71 Some important facts Inhaled air contains 21% oxygen 79% other gasses Exhaled air contains 16% oxygen 4% carbon dioxide

72 Why do we breath? The average healthy human breaths due to CO 2 drive Increased CO 2 levels in arterial blood detected in the brain stimulate inhalation COPD patients may breath due to a hypoxic drive Decreased arterial O 2 levels detected in the brain stimulate inhalation

73 Airway Adjuncts Mechanical devices that assist in keeping the airway patent (open & clear) Does not substitute for routine airway control (e.g. head tilt/chin lift) Oropharyngeal Airway OPA Nasopharyngeal Airway NPA Suction

74 Oropharyngeal Airway OPA Used in patients with no gag reflex who are unresponsive Must be sized correctly! Measured from the corner of the patients mouth to the tip of the earlobe or From the center of the patients mouth to the angle of the lower jawbone

75 One type of OPA

76 Inserting the OPA

77 Nasopharyngeal Airway NPA Can be used in conscious patients and is generally well tolerated Measured from the patients nostril to the earlobe or angle of the lower jawbone

78 NPA

79 Inserting the NPA

80 Suction Mechanical means of removing debris from the mouth or nose or throat area Two types Fixed on the ambulance Portable Suction for no more than 15 seconds As long as you comfortably hold your breath Suction Catheters Rigid ( Yankauer, Tonsil Tip ) Soft ( Whistle Tip )

81 Fixed Suction

82 Portable Suction A Fairly USELESS Device

83 Portable Electronic Suction

84 Yankauer Catheter

85 Whistle Tip Suction