Advanced Resuscitation Training
|
|
|
- Vincent Roberts
- 5 years ago
- Views:
Transcription
1 Advanced Resuscitation Training DANIEL DAVIS, MD People should not die before they are done living.
2 What makes ART unique? System of care Inpatient & prehospital Approach to education Cognitive psychology Curriculum breadth Reduce preventable death CQI data collection & analytics Six sigma-based Clinical outcomes Consistency across multiple institutions
3 System of Care
4 System of Care Best Practices Scientific Evidence CQI Training Technology
5 The ART Enchilada Screening Monitoring Early recognition Critical care (including procedural) Arrest resuscitation Post-arrest care End-of-life issues External Afferents Internal (Database) Technology Efferents Special projects Training
6 The ART Enchilada Screening Monitoring Early recognition Critical care (including procedural) Arrest resuscitation Post-arrest care End-of-life issues Scientific evidence Scientific evidence Scientific evidence Scientific evidence Scientific evidence Scientific evidence Scientific evidence External Past performance Other institutions Manuals/guides Consensus opinion Past performance Other institutions Manuals/guides Consensus opinion Past performance Other institutions Manuals/guides Consensus opinion Past performance Other institutions Manuals/guides Consensus opinion Past performance Other institutions Manuals/guides Consensus opinion Past performance Other institutions Manuals/guides Consensus opinion Past performance Other institutions Manuals/guides Consensus opinion Best practices Best practices Best practices Best practices Best practices Best practices Best practices Guidelines Guidelines Guidelines Guidelines Guidelines Guidelines Guidelines Afferents Internal (Database) Arrest rates Patient diagnoses Comorbidities Arrest classifications Preventability Risk-adjusted mortality Process issues Arrest rates Patient diagnoses Comorbidities Arrest classifications Preventability Risk-adjusted mortality Process issues Arrest rates Diagnoses/comorbidities Arrest classifications Rapid response Preventability Risk-adjusted mortality Process issues Arrest rates Diagnoses/comorbidities Arrest classifications Preventability ICU/ventilator days Risk-adjusted mortality Process issues ROSC Survival-to-discharge Good neuro outcomes Arrest-related deaths Arrest classifications CPR process measures Process issues OOHCA survival ROSC-to-survival ratio Temperature management Facilitated PCI Neurocritical care ICU/ventilator days CLBSI/VAP rates Code:DNAR mortality Rate of 2+ Code Blues Advanced directives Family discussions Palliative care consultation Withdrawal Organ donation Manual vitals Manual vitals Manual vitals Manual vitals Monitor Advanced monitoring Advanced monitoring Technology Monitor vitals Advanced monitoring Telemedicine Mechanical ventilation Monitor vitals Advanced monitoring Telemedicine Mechanical ventilation Monitor vitals MEWS/algorithms Advanced monitoring Telemedicine Monitor vitals MEWS/algorithms Advanced monitoring Telemedicine Defibrillator Mechanical compressor Circulatory enhancers Ventilation devices Perfusion Oxygenation Ventilation Temperature management Computer algorithms Prognostication Palliative care Temperature management Circulatory assist devices Circulatory assist devices Mechanical ventilation Mechanical ventilation Temperature management Percutaneous intervention Compassionate extubation Circulatory assist devices Circulatory assist devices ECMO Neurocritical care Family comfort Efferents Special projects Triage/disposition Monitoring Screening approaches Telemedicine Hospital configuration Alternate care strategies Triage/disposition Monitoring Screening approaches Telemedicine Hospital configuration MEWS/algorithms Triage/disposition Monitoring Rapid response Critical care Procedures Non-arrest codes Triage/disposition Monitoring Screening approaches Telemedicine Hospital configuration Alternate care strategies Recognition Monitoring Equipment Code team configuration Protocols Medications Processes Advanced monitoring Equipment Neurocritical care Hospital configuration Protocols Palliative care Prognostication Monitoring/equipment Neurocritical care Hospital configuration Palliative care Prognostication Family issues Organ donation Triage/disposition/monitoring Triage/disposition/monitoring Triage/disposition/monitoring ART Matrix Recognition ROSC Risk stratification ART Matrix ART Matrix ART Matrix Perfusion Compressions POV Prognostication Training Perfusion Oxygenation Ventilation Policies/protocols Perfusion Oxygenation Ventilation Policies/protocols Perfusion Oxygenation Ventilation Policies/protocols Oxygenation Ventilation Monitoring Procedures Ventilations Medications Monitoring Defibrillation Critical monitoring Temperature management Facilitated PCI Neurocritical care Patient/family discussion Conflict resolution Palliative care Ethics Peri-arrest Peri-arrest Peri-arrest Peri-arrest ROSC Reperfusion strategies Organ donation Recognition Recognition Recognition Recognition Rearrest End-of-life discussions
7 Approach to Education
8 How We Teach Cognitive psychology Affective domain Conceptual learning Vertical perspectivism Pattern recognition Multiple modalities Integrated technology
9 Curriculum Breadth
10 What We Teach Arrest prevention The Theory of Everything Arrest resuscitation CPR Island Critical Care Integrated Model of Physiology Airway Management Advanced Airway Resuscitation Training
11 Procedures Airway Resuscitation ACLS/BLS PALS ART NRP ATLS Ventilator Critical Care Specialty
12 The Theory of Everything Cancer Immobilization Coagulopathy Obesity Procedure Cancer Anticoagulation GI bleed ICU Trauma Ventilator COPD Infection Immunocompromised Lines/catheters/tubes Elderly/neonate Shock Acute Coronary Syndrome Coronary Artery Disease Known dysrhythmia Known CHF Renal failure Post-event Lupus Movement (ICU) Stimulation (ICU) Toilet Related Deaths Hypervagal Tracheostomy Secretions Bleeding Known ARDS (ICU) Known sleep apnea Narcotics/sedatives Post-procedure STOP BANG Snorking Asthma/COPD Known pulmonary disease Pulmonary edema Pneumonia Old/young Known TBI Post-craniotomy Undergoing RSI Known CVA Vasculopathy Anti-coagulation Post-craniotomy Brain tumor Elevated ICP AVM Hemorrhage/ Hypovolemia Tamponade/ Tension PTX VF/VT Vagal/block Tracheostomy Lung Disease TBI CVA Other PE Sepsis CHF ARDS Obstruction RSI Circulatory Dysrhythmic Respiratory Neurologic AIM Vitals, labs, x-ray, other AIM Exam, vitals, monitor, ECG AIM Vitals, labs, x-ray, other AIM Exam, vitals, ICP, x-ray, other SHOOT Supine IVF Pressors Blood Etiology-specific therapy VAD, ECMO SHOOT Supine IVF Meds Etiology-specific therapy Pacing, shock SHOOT Upright O 2 BVM PAP Etiology-specific therapy Intubation, ventilator SHOOT Upright osmotic ventilation Etiology-specific therapy Burr, ventriculostomy, surgery
13 Circulatory HR SBP COMPENSATED UNCOMPENSATED Time
14 Respiratory SpO2 RR Tidal Volume COMPENSATED UNCOMPENSATED Time
15 GENERAL ARREST ALGORITHM
16
17 Perfusion Ventilation Oxygenation
18 Prevent Hypoxic Arrest Overall Intubation Success Maximize 1 st Attempt Preoxygenate with NRB +/- NC SaO2>93% NRB 1-3 Preassessment 2 Normal Cric pressure Sedative Paralytic 4 SaO2>93% 1 st Look 5 External laryngeal manipulation (ELM) Assisted ventilation (small volume) 1 Anticipate problem Consider alternative approach 3 Access adjuncts Access cric kit Abandon attempt 6 SaO2 <93% BVM (large volume) 1 Unable to intubate Unsuccessful 1 st Attempt Able to intubate ELM VL, DL (Shoehorn) Supraglottic Unsuccessful 7 Successful BVM 1 /temp supraglottic (Consider other intubator or immediate transport) SaO2>93% Can t intubate, can oxygenate ELM VL, DL (Macler) Bougie Suction Supraglottic Cric Successful SaO2<93% Can t intubate, can t oxygenate Magills Bougie Cric Rapid Airway Access Partial response to BVM Brief attempts Successful Not responding to BVM 1 Two thumbs up BVM, cricoid pressure, NPA/OPA, EtCO2 2 Hypoxemia, Extremes of size, Anatomic disruption/obstruction, Vomit/blood/fluid, Exsanguination, Neck mobility (HEAVEN) 3 VL or DL without paralysis, primary supraglottic/cric 4 Paralytics contraindicated with suspected airway obstruction 5 VL (TBI/trauma/anatomic/extremely large) vs. DL (fluids/speed/extremely small) 6 SpO2 dropping below 93%, recognition of better alternative, bradycardia 7 Consider repeating RSI medications Unsuccessful Supraglottic Cric Successful BVM 1 until return of spontaneous respirations Confirm EtCO2 Chest rise Breath sounds SpO2
19 CQI Data/Analytics
20 ART Data/Analytics Institutional Operational Demographics Antecedent events Intra-arrest Post-arrest Process issues Clinical interpretation
21 Clinical Outcomes
22 Acceptable Compressions CCF (%) (%) Los Angeles EMS 100% 90% Pre ART 88% Post ART 80% 81% 82% 70% 60% 50% 40% Need Graph, % 30% 20% 10% 0% 0% 1% 2% Case 62 (pre) Case 65 (pre) Case 55 (pre) Case 74 (post) Case 72 (post) Case 71 (post)
23 Compressions in Target Before score w/o After score with feedback
24 Intubation Success (%) 100 Air Methods Intubations Overall First Attempt First Attempt without Desaturation Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q
25 ROSC (%) 35 Riverside RVCFD Arrest County Outcomes FD Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q
26 Survival (%) Colton FD Pre-ART Post-ART Survival to ED Admission
27 Survival-to-Discharge (%) UCSD Arrest Survival Survival Current U.S. Benchmark
28 Arrest Incidence (per 1000 admissions) UCSD Non-ICU Arrests Incidence
29 Hospital Mortality (% of Admissions) 2.2 UCSD Overall Hospital Mortality
30 Percent (%) Mayo Florida Mayo Arrest Florida Survival Pre-ART Post-ART Target Rate Target Depth CCF ROSC Survival Good Neuro
31 Survival to Discharge (%) 45 Geisinger Arrest Medical Survival Center
32 Non-ICU Arrests (#) 60 Ochsner Arrest Medical Incidence Center 50 Pre-ART Post-ART Sep/Oct Nov/Dec Jan/Feb Mar/Apr May/Jun Jul/Aug
33 Survival (%) An ART Movement Pre-ART Post-ART UCSD VA Other UC's Mayo ED CPR on Air Medical Santa El Cajon San Riverside Inpatient Witnessed EDArrival Air Barbara Ground Bernardino EMS
34
Capnography: The Most Vital Sign
Capnography: The Most Vital Sign Mike McEvoy, PhD, NRP, RN, CCRN Cardiac Surgical ICU RN & Chair Resuscitation Committee Albany Medical Center EMS Coordinator Saratoga County, NY www.mikemcevoy.com CO
INTUBATION/RSI. PURPOSE: A. To facilitate secure, definitive control of the airway by endotracheal intubation in an expeditious and safe manner
Manual: LifeLine Patient Care Protocols Section: Adult/Pediatrics Protocol #: AP1-009 Approval Date: 03/01/2018 Effective Date: 03/05/2018 Revision Due Date: 12/01/2018 INTUBATION/RSI PURPOSE: A. To facilitate
Advanced Cardiac Life Support (ACLS) Science Update 2015
1 2 3 4 5 6 7 8 9 Advanced Cardiac Life Support (ACLS) Science Update 2015 What s New in ACLS for 2015? Adult CPR CPR remains (Compressions, Airway, Breathing Chest compressions has priority over all other
SYSTEMS BASED APPROACH TO OUT-OF-HOSPITAL CARDIAC ARREST
SYSTEMS BASED APPROACH TO OUT-OF-HOSPITAL CARDIAC ARREST Kenneth A Scheppke, MD Chief Medical Officer Palm Beach County Fire Rescue State EMS Medical Director Florida Department of Health CASE REPORT 42
CPR What Works, What Doesn t
Resuscitation 2017 ECMO and ECLS April 1, 2017 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN Circulation 2013;128:417-35
Emergency Cardiac Care Guidelines 2015
Emergency Cardiac Care Guidelines 2015 VACEP 2016 William Brady, MD University of Virginia Guidelines 2015 Basic Life Support & Advanced Cardiac Life Support Acute Coronary Syndrome Pediatric Advanced
Don t let your patients turn blue! Isn t it about time you used etco 2?
Don t let your patients turn blue! Isn t it about time you used etco 2? American Association of Critical Care Nurses National Teaching Institute Expo Ed 2013 Susan Thibeault MS, CRNA, APRN, CCRN, EMT-P
Resuscitation Checklist
Resuscitation Checklist Actions if multiple responders are on scene Is resuscitation appropriate? Conditions incompatible with life Advanced decision in place Based on the information available, the senior
IN HOSPITAL CARDIAC ARREST AND SEPSIS
IN HOSPITAL CARDIAC ARREST AND SEPSIS MARGARET DISSELKAMP, MD OVERVIEW Background Epidemiology of in hospital cardiac arrest (IHCA) Use a case scenario to introduce new guidelines Review surviving sepsis
Question: Is this patient an infant? A patient less than 12 months old is considered an infant. Please check the box next to the appropriate choice.
Question: Date of Intubation (Month, Day, Year): Question: Date of Data Entry This should be within 4 weeks to the day of intubation: Question: Is this patient an infant? A patient less than 12 months
Emergency Department/Trauma Adult Airway Management Protocol
Emergency Department/Trauma Adult Airway Management Protocol Purpose: A standardized protocol for management of the airway in the setting of trauma in an academic center, with the goal of maximizing successful
ADVANCED AIRWAY MANAGEMENT
The Advanced Airway Management protocol should be used on all patients requiring advanced airway management procedures. This protocol is divided into three sections the Crash Airway Algorithm, the Rapid
SUMMARY OF MAJOR CHANGES 2010 AHA GUIDELINES FOR CPR & ECC
SUMMARY OF MAJOR CHANGES 2010 AHA GUIDELINES FOR CPR & ECC The following is a summary of the key issues and changes in the AHA 2010 Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac
Major Points. The ED-ICU Interface. Chain of Survival. It usually starts here
Major Points The ED-ICU Interface Robert M. Rodriguez, MD FAAEM Most ICU patients start in ED Chain of critical care starting in field and ED Collaborate, develop protocols (define roles), communicate
System Utilization 2013
System Utilization 2013 8000 7000 Contra Costa County 911 Ambulance Response and Transport By Month 2012 Through 2013 (2013 Data excludes SRVFD) Response 6000 5000 Transport 4000 3000 2000 1000 0 1/1/2012
Science Behind Resuscitation. Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013
Science Behind Resuscitation Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013 Conflict of Interest No Financial or Industrial Conflicts Slides: Drs. Nelson, Cole and Larabee
A silent chest is. Pediatrics II Asthma, seizures and cardiac arrest. Children are different. Cough variant asthma. Symptoms of severe distress
Asthma ~21% of all asthma cases are school aged Pediatrics II Asthma, seizures and cardiac arrest Identify 3 symptoms of an asthma exacerbation Bronchospasm Edema of the bronchi Increased mucus production
Beth Cetanyan, RN AHA RF Aka The GURU
* Beth Cetanyan, RN AHA RF Aka The GURU *Discuss common causes of Pediatric CA *Review current PALS Guidelines *Through case presentations and discussion, become more comfortable and confident in providing
Rapid Sequence Induction
Rapid Sequence Induction Virtual simultaneous administration, after preoxygenation, of a potent sedative agent and a rapidly acting neuromuscular blocking agent to facilitate rapid tracheal intubation
Resuscitation Science : Advancing Care for the Sickest Patients
Resuscitation Science : Advancing Care for the Sickest Patients William Hallinan University of Rochester What is resuscitation science? Simply the science of resuscitation : Pre arrest Arrest care Medical
County of Santa Clara Emergency Medical Services System
County of Santa Clara Emergency Medical Services System Policy #700-M12: Continuous Positive Airway Pressure CONTINUOUS POSITIVE AIRWAY PRESSURE Effective: February 8, 2013TBD Replaces: NewFebruary 8,
Michigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS
Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Pediatric Asystole Section 4-1 Pediatric Bradycardia Section 4-2 Pediatric Cardiac Arrest General Section 4-3 Pediatric Narrow Complex Tachycardia
No conflicts of interest
Robert M. Rodriguez, MD FAAEM Clinical Professor of Medicine and Emergency Medicine, UCSF No conflicts of interest Major Points Most ICU patients start in ED Chain of critical care starting in field and
Updated Policies and Procedures # s 606, 607, 610, 611, 612, 613, 625, 628, 630, 631, and 633 (ACLS Protocols and Policies)
SLO County Emergency Medical Services Agency Bulletin 2012-09 PLEASE POST Updated Policies and Procedures # s 606, 607, 610, 611, 612, 613, 625, 628, 630, 631, and 633 (ACLS Protocols and Policies) July
2014 UCSD Medical Center. Basic Resuscitation Training Manual. Copyright 2014 UC Regents
2014 UCSD Medical Center Basic Resuscitation Training Manual Copyright 2014 UC Regents Overview Resuscitation science is undergoing a renaissance, with a rapid expansion of our understanding of the physiology
Interesting Capnography Cases
Interesting Capnography Cases Mike McEvoy, PhD, NRP, RN, CCRN Cardiac Surgical ICU RN & Chair Resuscitation Committee Albany Medical Center EMS Coordinator Saratoga County, NY www.mikemcevoy.com Outline
Consider Treatable Underlying Causes Early
Page 1 of 8 Cardiac Arrest Timeout Checklist Assign roles for Pit Crew CPR o Compressors x 2 o Airway o Lead responsible for coordinating team, making decisions o Medications Continuous compressions at
MICHIGAN. State Protocols. Pediatric Cardiac Table of Contents 6.1 General Pediatric Cardiac Arrest 6.2 Bradycardia 6.
MICHIGAN State Protocols Protocol Number Protocol Name Pediatric Cardiac Table of Contents 6.1 General Pediatric Cardiac Arrest 6.2 Bradycardia 6.3 Tachycardia PEDIATRIC CARDIAC PEDIATRIC CARDIAC ARREST
Pediatric Cardiac Arrest General
Date: November 15, 2012 Page 1 of 5 Pediatric Cardiac Arrest General This protocol should be followed for all pediatric cardiac arrests. If an arrest is of a known traumatic origin refer to the Dead on
Preparing for your upcoming PALS course
IU Health PALS Study Guide Preparing for your upcoming PALS course UPDATED November 2016 Course Curriculum: 2015 American Heart Association (AHA) Guidelines for Pediatric Advanced Life Support (PALS) AHA
OWN THE AIRWAY. Airway Management Bruce Barry, RN, CEN, CPEN, TCRN, NRP. Paramedic Program
OWN THE AIRWAY Airway Management Bruce Barry, RN, CEN, CPEN, TCRN, NRP The largest detriment to airway management has nothing to do with the patient, but everything to do with you as a provider. PRACTICE..PRACTICE.PRACTICE.
Airway Management. Teeradej Kuptanon, MD
Airway Management Teeradej Kuptanon, MD Outline Anatomy Detect difficult airway Rapid sequence intubation Difficult ventilation Difficult intubation Surgical airway access ICU setting Intubation Difficult
Advanced Airway Management PRESENTED BY: JOSIAH POIRIER RN, JOHN GRUBER FP-C
Advanced Airway Management PRESENTED BY: JOSIAH POIRIER RN, JOHN GRUBER FP-C Advanced Airway Objectives Advanced airway management is a relatively low frequency, high risk intervention. The following education
Veno-Venous ECMO Support. Chris Cropsey, MD Sept. 21, 2015
Veno-Venous ECMO Support Chris Cropsey, MD Sept. 21, 2015 Objectives List indications and contraindications for ECMO Describe hemodynamics and oxygenation on ECMO Discuss evidence for ECMO outcomes Identify
Out-of-hospital Cardiac Arrest. Franz R. Eberli MD, FESC, FAHA Cardiology Triemli Hospital Zurich, Switzerland
Out-of-hospital Cardiac Arrest Franz R. Eberli MD, FESC, FAHA Cardiology Triemli Hospital Zurich, Switzerland Conflict of Interest I have no conflict of interest to disclose regarding this presentation.
3. D Objective: Chapter 4, Objective 4 Page: 79 Rationale: A carbon dioxide level below 35 mmhg indicates hyperventilation.
1. A Objective: Chapter 1, Objective 3 Page: 14 Rationale: The sudden increase in acceleration produces posterior displacement of the occupants and possible hyperextension of the cervical spine if the
IFT1 Interfacility Transfer of STEMI Patients. IFT2 Interfacility Transfer of Intubated Patients. IFT3 Interfacility Transfer of Stroke Patients
IFT1 Interfacility Transfer of STEMI Patients IFT2 Interfacility Transfer of Intubated Patients IFT3 Interfacility Transfer of Stroke Patients Interfacility Transfer Guidelines IFT 1 TRANSFER INTERFACILITY
Cardiopulmonary Resuscitation in Adults
Cardiopulmonary Resuscitation in Adults Fatma Özdemir, MD Emergency Deparment of Uludag University Faculty of Medicine OVERVIEW Introduction Pathophysiology BLS algorithm ALS algorithm Post resuscitation
Exclusion Criteria 1. Operator or supervisor feels specific intra- procedural laryngoscopy device will be required.
FELLOW Study Data Analysis Plan Direct Laryngoscopy vs Video Laryngoscopy Background Respiratory failure requiring endotracheal intubation occurs in as many as 40% of critically ill patients. Procedural
Competency Log Professional Responder Courses
Competency Log Professional Responder Courses Check off each competency once successfully demonstrated. This log may be used as a support tool when teaching a Professional Responder course. Refer to the
ACLS Prep. Preparation is key to a successful ACLS experience. Please complete the ACLS Pretest and Please complete this ACLS Prep.
November, 2013 ACLS Prep Preparation is key to a successful ACLS experience. Please complete the ACLS Pretest and Please complete this ACLS Prep. ACLS Prep Preparation is key to a successful ACLS experience.
They aren t the same thing. Daniel Dunham
They aren t the same thing Daniel Dunham Capnometry Displays the value (as a number) of the partial pressure of CO2 Capnography Waveform capnography shows (as a wave) the change in CO2 over time Both are
Michigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS
Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Pediatric Asystole Section 4-1 Pediatric Bradycardia Section 4-2 Pediatric Cardiac Arrest General Section 4-3 Pediatric Narrow Complex Tachycardia
Airway Management and The Difficult Airway
Airway Management and The Difficult Airway Gary McCalla, MD, FACEP Medical Director REACH Air Medical Services Services 1 It is not enough to do your best, unless you have prepared to be the best. -John
2014 UCSD Medical Center. Advanced Resuscitation Training Manual. Copyright 2014 UC Regents
2014 UCSD Medical Center Advanced Resuscitation Training Manual Copyright 2014 UC Regents Table of Contents 2 Table of contents 2 Overview 3 Core concepts 3 Cardiopulmonary arrest algorithm 4 Initial assessment
AVOIDING THE CRASH: OPTIMIZE YOUR PRE, PERI, AND POST AIRWAY MANAGEMENT AVOIDING THE CRASH 1: DON T INTUBATE, OPTIMIZE PRE-AIRWAY MANAGEMENT
AVOIDING THE CRASH: OPTIMIZE YOUR PRE, PERI, AND POST AIRWAY MANAGEMENT Robert J. Vissers MD Chief, Emergency Medicine, Quality Chair, Legacy Emanuel Medical Center Adjunct Associate Professor, OHSU Portland,
Capnography 101. James A Temple BA, NRP, CCP
Capnography 101 James A Temple BA, NRP, CCP Expected Outcomes 1. Gain a working knowledge of the physiology and science behind End-Tidal CO2. 2.Relate End-Tidal CO2 to ventilation, perfusion, and metabolism.
In-hospital Care of the Post-Cardiac Arrest Patient. David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine
In-hospital Care of the Post-Cardiac Arrest Patient David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine Disclosures I have no financial interest, arrangement,
Airway Management Adult
Airway Management Adult Goals: Provide effective oxygenation and ventilation; recognize and alleviate respiratory distress or failure; provide necessary interventions quickly and safely to patients who
ICEMA Protocol Updates. October 15, 2016
ICEMA Protocol Updates October 15, 2016 ICEMA disclosure The following protocol updates include changes in ICEMA s paramedic (EMT P) optional scope of practice. Medical Advisory Committee (MAC) representatives,
Post Cardiac Arrest Care 2015 American Heart Association Guideline Update for CPR and Emergency Cardiovascular Care
Post Cardiac Arrest Care 2015 American Heart Association Guideline Update for CPR and Emergency Cardiovascular Care รศ.ดร.พญ.ต นหยง พ พานเมฆาภรณ ภาคว ชาว ส ญญ ว ทยา คณะแพทยศาสตร มหาว ทยาล ยเช ยงใหม System
Paediatric Resuscitation. EMS Rounds Gurinder Sangha MD Paediatric Emergency Fellow June 18, 2009
Paediatric Resuscitation EMS Rounds Gurinder Sangha MD Paediatric Emergency Fellow June 18, 2009 Essentials of Resuscitation Airway Breathing Circulation AIRWAY Differences in Paediatric Airway Shorter
2015 AHA Guidelines: Pediatric Updates
2015 AHA Guidelines: Pediatric Updates Advances in Pediatric Emergency Medicine December 9, 2016 Karen O Connell, MD, MEd Associate Professor of Pediatrics and Emergency Medicine Emergency Medicine and
Prehospital Post Arrest Care AHA Strive to Revive 2017 November 3, 2017
Prehospital Post Arrest Care AHA Strive to Revive 2017 November 3, 2017 Jon Rittenberger, MD, MS Department of University of Pittsburgh Employers: Disclosures - Rittenberger University of Pittsburgh UPMC
Prehospital Resuscitation for the 21 st Century Simulation Case. VF/Asystole
Prehospital Resuscitation for the 21 st Century Simulation Case VF/Asystole Case History 1 (hypovolemic cardiac arrest secondary to massive upper GI bleed) 56 year-old male patient who fainted in the presence
All bedside percutaneously placed tracheostomies
Page 1 of 5 Scope: All bedside percutaneously placed tracheostomies Population: All ICU personnel Outcomes: To standardize and outline the steps necessary to safely perform a percutaneous tracheostomy
ETCO2 MONITORING NON-INTUBATED PATIENTS
Although the standard of care in ETC02 is well established for intubated patients, there has been little emphasis on the use of capnography in nonintubated patients till now. In addition to confirming
Hanna K. Al-Makhamreh, M.D., FACC Interventional Cardiologist
Hanna K. Al-Makhamreh, M.D., FACC Interventional Cardiologist Introduction. Basic Life Support (BLS). Advanced Cardiac Life Support (ACLS). Cardiovascular diseases (CVDs) are the number one cause of death
Condensed version.
I m Stu 3 Condensed version smcvicar@uwhealth.org Listen 1. Snoring 2. Gurgling 3. Hoarseness 4. Stridor (inspiratory/expiratory) 5. Wheezing 6. Grunting Listen Crackles Wheezing Stridor Absent Crackles
Science Behind CPR Update from Darrell Nelson, MD, FACEP Emergency Medicine Wake Forest University Health Sciences
Science Behind CPR Update from 2010 Darrell Nelson, MD, FACEP Emergency Medicine Wake Forest University Health Sciences FRAMING THE DISCUSSION NO ONE SURVIVES CARDIAC ARREST, EXCEPT ON TV Conflicts of
PRACTICE GUIDELINE. DEFINITIONS: Mild head injury: Glasgow Coma Scale* (GCS) score Moderate head injury: GCS 9-12 Severe head injury: GCS 3-8
PRACTICE GUIDELINE Effective Date: 9-1-2012 Manual Reference: Deaconess Trauma Services TITLE: TRAUMATIC BRAIN INJURY GUIDELINE OBJECTIVE: To provide practice management guidelines for traumatic brain
Unit 4 Problems of Cardiac Output and Tissue Perfusion
Unit 4 Problems of Cardiac Output and Tissue Perfusion Lemone and Burke Ch 30-32 Objectives Review the anatomy and physiology of the cardiovascular system. Identify normal heart sounds and relate them
ACLS/ACS Updates 2015
ACLS/ACS Updates 2015 Advanced Cardiovascular Life Support by: Fareed Al Nozha, JBIM, ABIM, FKFSH&RC(Cardiology) Consultant Cardiologist Faculty, National CPR Committee, ACLS Program Head, SHA Dr Abdulhalim
3/30/12. Luke J. Gasowski BS, BSRT, NREMT-P, FP-C, CCP-C, RRT-NPS
Luke J. Gasowski BS, BSRT, NREMT-P, FP-C, CCP-C, RRT-NPS 1) Define and describe ETCO 2 2) Explain methods of measuring ETCO 2 3) Describe various clinical applications of ETCO 2 4) Describe the relationship
Paramedic Rounds. Pre-Hospital Continuous Positive Airway Pressure (CPAP)
Paramedic Rounds Pre-Hospital Continuous Positive Airway Pressure (CPAP) Morgan Hillier MD Class of 2011 Dr. Mike Peddle Assistant Medical Director SWORBHP Objectives Outline evidence for pre-hospital
Outcomes From Severe ARDS Managed Without ECMO. Roy Brower, MD Johns Hopkins University Critical Care Canada Forum Toronto November 1, 2016
Outcomes From Severe ARDS Managed Without ECMO Roy Brower, MD Johns Hopkins University Critical Care Canada Forum Toronto November 1, 2016 Severe ARDS Berlin Definition 2012 P:F ratio 100 mm Hg Prevalence:
Manual Defibrillation. CPR AGE: 18 years LOA: Altered HR: N/A RR: N/A SBP: N/A Other: N/A
ROC AMIODARONE, LIDOCAINE OR PLACEBO FOR OUT OF HOSPITAL CARDIAC ARREST DUE TO VENTRICULAR FIBRILLATION OR TACHYCARDIA (ALPS) STUDY: MEDICAL CARDIAC ARREST MEDICAL DIRECTIVE An Advanced Care Paramedic
Post Resuscitation (ROSC) Care
Standard Operating Procedure 2.10 Post Resuscitation (ROSC) Care Position Responsible: Medical Director Approved: Clinical Governance Committee Related Documents: This document is the intellectual property
Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: Pediatric Revised: 11/2013
Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: Pediatric Revised: 11/2013 (10 questions from this outline in the blue section) Emergency Medical
1 Pediatric Advanced Life Support Science Update What s New for 2010? 3 CPR. 4 4 Steps of BLS Survey 5 CPR 6 CPR.
1 Pediatric Advanced Life Support Science Update 2010 2 What s New for 2010? 3 CPR Take no longer than seconds for pulse check Rate at least on per minute (instead of around 100 per minute ) Depth change:
Capnography: The Most Vital of Vital Signs. Tom Ahrens, PhD, RN, FAAN Research Scientist, Barnes-Jewish Hospital, St. Louis, MO May, 2017
Capnography: The Most Vital of Vital Signs Tom Ahrens, PhD, RN, FAAN Research Scientist, Barnes-Jewish Hospital, St. Louis, MO May, 2017 Assessing Ventilation and Blood Flow with Capnography Capnography
Dr Alireza Yarahmadi and Dr Arvind Perathur Mercy Medical Center - Winter Retreat Des Moines February 2012
Dr Alireza Yarahmadi and Dr Arvind Perathur Mercy Medical Center - Winter Retreat Des Moines February 2012 Why screen of OSA prior to surgery? What factors increase the risk? When due to anticipate problems?
Northwest Community EMS System August 2018 CE: Sepsis and Septic Shock Credit Questions
Northwest Community EMS System August 2018 CE: Sepsis and Septic Shock Credit Questions Name: EMS Agency/hospital: EMSC/Educator reviewer: Date submitted: Credit awarded (date): Returned for revisions:
Rowan County EMS. I m p r o v i n g C a r d i a c A r r e s t S u r v i v a l. Christopher Warr NREMT-P Lieutenant.
Rowan County EMS I m p r o v i n g C a r d i a c A r r e s t S u r v i v a l Christopher Warr NREMT-P Lieutenant Rowan County EMS christopher.warr@rowancountync.gov September 9, 2012 2:44 11:44:00 Mr.
Update on Sudden Cardiac Death and Resuscitation
Update on Sudden Cardiac Death and Resuscitation Ashish R. Panchal, MD, PhD Medical Director Center for Emergency Medical Services Assistant Professor Clinical Department of Emergency Medicine The Ohio
Resuscitation Patient Management Tool May 2015 MET Event
OPTIONAL: Local Event ID: Date/Time MET was activated: Time Not Documented MET 2.1 Pre-Event Pre-Event Tab Was patient discharged from an Intensive Care Unit (ICU) at any point during this admission and
Capnography Could Make You a Rock Star!
Capnography Could Make You a Rock Star! Mike McEvoy, PhD, RN, CCRN, NRP Staff RN CTICU and Resuscitation Committee Chair Albany Medical Center, New York EMS Coordinator Saratoga County, New York EMS Editor
It costs you nothing, but gains everything for your patient!
It costs you nothing, but gains everything for your patient! Attend the entire presentation Complete and submit the evaluation This session is approved for: ANCC hours CECBEMS hours No partial credit will
Restore adequate respiratory and circulatory conditions. Reduce pain
Pre-hospital management of the trauma patient is best performed by an integrated team focused on minimizing the time from injury to definitive care at an appropriate trauma center. Dispatchers, first responders,
Disclosures. Overview. Cardiopulmonary Arrest: Quality Measures 5/29/2014. In-Hospital Cardiac Arrest: Measuring Effectiveness and Improving Outcomes
Disclosures In-Hospital Cardiac Arrest: Measuring Effectiveness and Improving Outcomes Research support from UCOP CHQI award J. Matthew Aldrich, MD Anesthesia & Critical Care UCSF Overview Epidemiology
Head injuries. Severity of head injuries
Head injuries ED Teaching day 23 rd October Severity of head injuries Minor GCS 14-15 Must not have any of the following: Amnesia 10min Neurological sign or symptom Skull fracture (clinically or radiologically)
Update on Sudden Cardiac Death and Resuscitation
Update on Sudden Cardiac Death and Resuscitation Ashish R. Panchal, MD, PhD Medical Director Center for Emergency Medical Services Assistant Professor Clinical Department of Emergency Medicine The Ohio
The Future of EMS as Revealed through Research. A Window into the Near Future
The Future of EMS as Revealed through Research A Window into the Near Future Raymond L. Fowler, M.D., FACEP Co-Principal Investigator National Institutes of Health Resuscitation Outcomes Consortium --------------------
Routine Patient Care Guidelines - Adult
Routine Patient Care Guidelines - Adult All levels of provider will complete an initial & focused assessment on every patient, and as standing order, use necessary and appropriate skills and procedures
ITLS Advanced Pre-Test Annotated Key 8 th Edition
1. A Objective: Chapter 1, Objective 3 Page: 14 Rationale: The sudden increase in acceleration produces posterior displacement of the occupants and possible hyperextension of the cervical spine if the
Disclosures. Extra-Corporeal Membrane Oxygenation During Cardio- Pulmonary Resuscitation ECPR April 22, 2016 ECG. Case. Case. Case Summary 4/22/2016
Extra-Corporeal Membrane Oxygenation During Cardio- Pulmonary Resuscitation ECPR April 22, 2016 Nothing to disclose. Disclosures Ivan J Chavez MD Case ECG History 60 y/o male No prior history of CAD In
Emergency Cardiovascular Care: EMT-Intermediate Treatment Algorithms. Introduction to the Algorithms
Emergency Cardiovascular Care: EMT-Intermediate Treatment Algorithms Introduction to the Algorithms Cardiac Arrest Algorithms Prehospital Medication Profiles Perspective regarding the EMT- Intermediate
Regionalization of Post-Cardiac Arrest Care
Regionalization of Post-Cardiac Arrest Care David A. Pearson, MD, FACEP, FAAEM Department of Emergency Medicine Disclosures I have no financial interest, arrangement, or affiliations and no commercial
EMS System Key Performance Indicator Data Quality Rules Clinical Group/ Key Performance Indicators (KPIs)
EMS System Key Performance Indicator Data Quality Rules 1. Critical Trauma Patient Management 1.1 Percent of Step 1 and Step 2 trauma patients with an EMS scene time of less than 10 minutes. (arrival-to-departure
4. Which survey program does your facility use to get your program designated by the state?
TRAUMA SURVEY Please complete one survey for each TCD designation you have in your facility. There would be a maximum of three surveys completed if your facility was designated as a trauma, stroke and
PROBLEM: Shock refractory VF/pVT BACKGROUND: Both in 2015 CoSTR. Amiodarone favoured.
Question Should AMIODARONE vs LIDOCAINE be used for adults with shock refractory VF/pVT PROBLEM: Shock refractory VF/pVT BACKGROUND: Both in 2015 CoSTR. Amiodarone favoured. OPTION: AMIODARONE plus standard
ST Elevation Myocardial Infarction (STEMI) Reperfusion Order Set
Form Title Form Number CH-0454 2018, Alberta Health Services, CKCM This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. The license does not
Airway Management. Key points. Rapid Sequence Intubation. Rapid Sequence Intubation Recognizing difficult airway Managing difficult airway
Airway Management Prasha Ramanujam and Guy Shochat Department of Emergency Medicine UCSF Medical Center Key points Rapid Sequence Intubation Recognizing difficult airway Managing difficult airway Rapid
By Mark Bachand, RRT-NPS, RPFT. I have no actual or potential conflict of interest in relation to this presentation.
By Mark Bachand, RRT-NPS, RPFT I have no actual or potential conflict of interest in relation to this presentation. Objectives Review state protocols regarding CPAP use. Touch on the different modes that
Yolo County Health & Human Services Agency
Yolo County Health & Human Services Agency Kristin Weivoda EMS Administrator John S. Rose, MD, FACEP Medical Director DATE: December 28, 2017 TO: Yolo County Providers and Agencies FROM: Yolo County EMS
Therapeutic hypothermia
INDUCED HYPOTHERMIA Dr. Attilla Kiss M.D. Acting Medical Director Emergency Services EMS Medical Director St. John Medical Center OBJECTIVES Define and explain Induced Hypothermia Discuss both pre-hospital
TEACHING BASIC LIFE SUPPORT (& ALS)
TEACHING BASIC LIFE SUPPORT (& ALS) Anton Koželj, R.N., B. Sc., lecturer Faculty of Health Sciences, University of Maribor Žitna ulica 15, 2000 Maribor, Slovenia Fact s To know-how to perform basic life
Web Appendix 1: Literature search strategy. BTS Acute Hypercapnic Respiratory Failure (AHRF) write-up. Sources to be searched for the guidelines;
Web Appendix 1: Literature search strategy BTS Acute Hypercapnic Respiratory Failure (AHRF) write-up Sources to be searched for the guidelines; Cochrane Database of Systematic Reviews (CDSR) Database of
CARDIAC ARREST IN SPECIAL CIRCUMSTANCES 2
CARDIAC ARREST IN SPECIAL CIRCUMSTANCES 2 M1 Objectives To understand how resuscitation techniques should be modified in the special circumstances of: Hypothermia Immersion and submersion Poisoning Pregnancy
Prehospital Care Bundles
Prehospital s The MLREMS Prehospital s have been created to provide a simple framework to help EMS providers identify the most critical elements when caring for a patient. These bundles do not replace