County of Santa Clara Emergency Medical Services System
|
|
- Myron Felix Fowler
- 6 years ago
- Views:
Transcription
1 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, 2013 Review: November 2014TBD I. Purpose The purpose of this policy is to describe the process of initiating and managing continuous positive airway pressure (CPAP) to patients and required equipment. A. Goals of CPAP 1. Normally the patient should improve in the first five minutes of CPAP. Signs of improvement include: a. Elimination of dyspnea b. Decreased respiratory rate c. Decreased heart rate d. Increased SpO2 e. Stabilized BP 2. Should the patient fail to improve with CPAP, remove the CPAP device and assist ventilations with BVM or intubate patient. Signs and symptoms of failure to improve include the following: a. Sustained or increased heart rate b. Sustained or increased respiratory rate c. Sustained or increased BP d. Sustained or decreasing pulse oximetry readings, and/or e. Decreased level of consciousness II. Definitions Introduction Prehospital CPAP treatment in patients with Acute Pulmonary Edema can improve oxygenation significantly and lower respiratory rate, heart rate, and systolic blood pressure. Continuous positive airway pressure (CPAP) may reduce the need for intubation and mechanical ventilation in patients with acute hypoxemic respiratory insufficiency. Noninvasive ventilation (NIV) has been associated with lower rates of endotracheal intubation in populations of patients with acute respiratory failure. Page 1 of 4
2 III. Indications A. CPAP is indicated for patients in severe respiratory distress that meet the following criteria: 1. The patient is 8 years old or greater and: a. There is a medical history of CHF with pulmonary edema with one or more of the following present: 1) Pedal edema 2) Orthopnea (SOB while lying supine) 3) Anxiety 4) Diaphoresis (perfuse sweating) 5) Current prescription of Digoxin of Lasix 6) Sudden onset of SOB Or b. The patient displays signs and symptoms of: 1) Severe asthma attack 2) COPD exacerbation 3) Near drowning 4) Severe respiratory distress B. CPAP is indicated for patients in severe respiratory distress with a DNR/POLST form that stipulates comfort care. Indications Age > 8 years old. History of CHF with Pulmonary Edema and one or more of the following: o Pedal Edema. o Taking Digoxin or Lasix. o Orthopnea. o Severe or sudden onset SOB. o Anxious. o Rales or coarse wheezes. o Diaphoresis. o Hypertension. OR Near Drowning. Severe respiratory distress. IV. Contraindications Contraindications A. Absolute Contraindications (DO NOT USE): Page 2 of 4
3 o1. Age is <less than 8 years old o2. Respiratory or cardiac arrest o3. Agonal respiration o4. Severely depressed level of consciousness o5. Systolic BP <is less than 90 mmhg o6. Signs and symptoms of pneumothorax o7. Inability to maintain airway patency o8. Major trauma, especially head injury with increased ICP or significant chest trauma o9. Facial anomalies or trauma (e.g., burns, fractures) o10. Patients that have an increased risk of aspirationvomiting B. Relative contraindications (USE CAUTIOUSLY): o1. History of pulmonary fibrosis o2. Decreased LOC o3. Claustrophobia or unable to tolerate mask (after first 1-2 minutes trial) V. Equipment A. Santa Clara County approved CPAP delivery system Equipment Boussignac CPAP system. Oxygen tank with flow rate regulator that can achieve 25 l/min (25 LPM flow will achieve CPAP of 8-10 cm H2O). VI. Procedure Procedure A. Place patient in a seated position with legs dependent. Monitor ECGVS (BP, HR, RR, SpO2) B. Apply the county approved CPAP mask/device to the patient Attach hose to an O2 tank capable of 25 LPM flow rate and place mask on patient. A liter flow of 25 LPM will provide approximately 8-10 cm of water pressure. C. Provide patient reassurance. that tthis will assist to alleviate breathing problems. D. If indicated, NTG spray can be given through the open port, or simply remove the mask long enough to spray. E. Indicate that CPAP is being used when giving the ring down report so the ED can be ready to maintain the procedure on arrival to ED. F. Monitor ECG and v/s (including: BP, HR, RR, SpO2), every five (5) minutes. Page 3 of 4
4 G. If there is no improvement in v/s or mentation within five (5) minutes, consider the need for an advanced airway and discontinue CPAP. H. Documentation shall include ECG, v/s, patient s response to treatment, and any adverse event related to treatment. VII. Complications Complications A. Hypotension. B. C. Pneumothorax. Corneal drying. Goals of CPAP Normally the patient should improve in the first five minutes of CPAP. Signs of improvement include: Elimination of dyspnea. Decreased respiratory rate. Decreased heart rate. Increased SpO2. Stabilized BP. Failure to improve Should the patient fail to improve with CPAP, remove the CPAP device and assist ventilations with BVM or intubate patient. Signs and symptoms of failure to improve include the following: Sustained or increased heart rate. Sustained or increased respiratory rate. Sustained or increased BP. Sustained or decreasing pulse oximetry readings, and/or Decreased level of consciousness. Documentation The use of CPAP must be documented on the PCR. VS (BP, HR, RR and SpO2) must be documented every 5 minutes. In the narrative section of the PCR, document the patient s response to CPAP. Any adverse event related to the use of CPAP. Indicate that CPAP is being used when giving the ring down report so the ED can be ready to maintain the procedure on arrival to the ED. Page 4 of 4
5 County of Santa Clara Emergency Medical Services System Policy #700-M12: Continuous Positive Airway Pressure CONTINUOUS POSITIVE AIRWAY PRESSURE Effective: February 12, 2015 Replaces: February 8, 2013 Review: November 12, 2017 I. Purpose The purpose of this policy is to describe the process of initiating and managing continuous positive airway pressure (CPAP) to patients and required equipment. A. Goals of CPAP 1. Normally the patient should improve in the first five minutes of CPAP. Signs of improvement include: a. Elimination of dyspnea b. Decreased respiratory rate c. Decreased heart rate d. Increased SpO2 e. Stabilized BP 2. Should the patient fail to improve with CPAP, remove the CPAP device and assist ventilations with BVM or intubate patient. Signs and symptoms of failure to improve include the following: a. Sustained or increased heart rate b. Sustained or increased respiratory rate c. Sustained or increased BP d. Sustained or decreasing pulse oximetry readings, and/or e. Decreased level of consciousness II. Definitions Prehospital CPAP treatment in patients with Acute Pulmonary Edema can improve oxygenation significantly and lower respiratory rate, heart rate, and systolic blood pressure. Continuous positive airway pressure (CPAP) may reduce the need for intubation and mechanical ventilation in patients with acute hypoxemic respiratory insufficiency. Noninvasive ventilation (NIV) has been associated with lower rates of endotracheal intubation in populations of patients with acute respiratory failure. Page 1 of 3
6 III. Indications A. CPAP is indicated for patients in severe respiratory distress that meet the following criteria: 1. The patient is 8 years old or greater and: a. There is a medical history of CHF with pulmonary edema with one or more of the following present: 1) Pedal edema 2) Orthopnea (SOB while lying supine) 3) Anxiety 4) Diaphoresis (perfuse sweating) 5) Current prescription of Digoxin of Lasix 6) Sudden onset of SOB Or b. The patient displays signs and symptoms of: 1) Severe asthma attack 2) COPD exacerbation 3) Near drowning 4) Severe respiratory distress B. CPAP is indicated for patients in severe respiratory distress with a DNR/POLST form that stipulates comfort care. IV. Contraindications A. Absolute Contraindications (DO NOT USE): 1. Age is less than 8 years old 2. Respiratory or cardiac arrest 3. Agonal respiration 4. Severely depressed level of consciousness 5. Systolic BP is less than 90 mmhg 6. Signs and symptoms of pneumothorax 7. Inability to maintain airway patency 8. Major trauma, especially head injury with increased ICP or significant chest trauma 9. Facial anomalies or trauma (e.g., burns, fractures) 10. Patients that have an increased risk of aspiration B. Relative contraindications (USE CAUTIOUSLY): 1. History of pulmonary fibrosis 2. Decreased LOC 3. Claustrophobia or unable to tolerate mask (after first 1-2 minutes) Page 2 of 3
7 V. Equipment A. Santa Clara County approved CPAP delivery system VI. Procedure A. Place patient in a seated position with legs dependent. B. Apply the county approved CPAP mask/device to the patient C. Provide patient reassurance. This will assist to alleviate breathing problems. D. If indicated, NTG spray can be given through the open port, or simply remove the mask long enough to spray. E. Indicate that CPAP is being used when giving the ring down report so the ED can be ready to maintain the procedure on arrival to ED. F. Monitor ECG and v/s (including: BP, HR, RR, SpO2), every five (5) minutes. G. If there is no improvement in v/s or mentation within five (5) minutes, consider the need for an advanced airway and discontinue CPAP. H. Documentation shall include ECG, v/s, patient s response to treatment, and any adverse event related to treatment. VII. Complications A. Hypotension. B. Pneumothorax. C. Corneal drying. Page 3 of 3
CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP)
CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) Continuous Positive Airway Pressure (CPAP) may be used as an adjunctive therapy for the treatment of patients with suspected Acute Pulmonary Edema, Chronic Obstructive
More informationParamedic 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
More informationPOLICY. Number: Title: APPLICATION OF NON INVASIVE VENTILATION FOR ACUTE RESPIRATORY FAILURE. Authorization
POLICY Number: 7311-60-024 Title: APPLICATION OF NON INVASIVE VENTILATION FOR ACUTE RESPIRATORY FAILURE Authorization [ ] President and CEO [ x ] Vice President, Finance and Corporate Services Source:
More informationUpdated 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
More informationNIV - BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP)
Introduction NIV - BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP) Noninvasive ventilation (NIV) is a method of delivering oxygen by positive pressure mask that allows for the prevention or postponement of invasive
More informationI. Subject: Continuous Positive Airway Pressure CPAP by Continuous Flow Device
I. Subject: Continuous Positive Airway Pressure CPAP by Continuous Flow Device II. Policy: Continuous Positive Airway Pressure CPAP by the Down's system will be instituted by Respiratory Therapy personnel
More informationCPAP. Pre-Hospital Treatment Using The Respironics Whisperflow CPAP Device. Charlottesville Albemarle Rescue Squad - CPAP
CPAP Pre-Hospital Treatment Using The Respironics Whisperflow CPAP Device CPAP What Is It? C ontinuous P ositive A irway P ressure Anatomy Review Anatomy Review Anatomy Review Alveoli Anatomy Review Chest
More informationNON-INVASIVE VENTILATION. Lijun Ding 23 Jan 2018
NON-INVASIVE VENTILATION Lijun Ding 23 Jan 2018 Learning objectives What is NIV The difference between CPAP and BiPAP The indication of the use of NIV Complication of NIV application Patient monitoring
More informationNIV in Acute Respiratory Failure: Where we fail? Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity
NIV in Acute Respiratory Failure: Where we fail? Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Use of NIV 1998-2010 50 45 40 35 30 25 20 15 10 5 0 1998
More informationEvaluation of the Effect of Prehospital Application of Continuous Positive Airway Pressure Therapy in Acute Respiratory Distress
BRIEF REPORT Evaluation of the Effect of Prehospital Application of Continuous Positive Airway Pressure Therapy in Acute Respiratory Distress G. Scott Warner, MD, FACP, FCCP Cullman Emergency Medical Services,
More informationTraining. Continuous Positive Airway Pressure (CPAP)
Training The training module will follow the national standard curriculum as it relates to the application and use of CPAP. The proposed curriculum will closely resemble the following algorithm utilizing
More informationNon-invasive Ventilation protocol For COPD
NHS LANARKSHIRE MONKLANDS HOSPITAL Non-invasive Ventilation protocol For COPD April 2017 S Baird Review Date: Oct 2019 Approved by Medical Directorate Indications for Non-Invasive Ventilation (NIV) NIV
More informationWhat is the next best step?
Noninvasive Ventilation William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center What is the next best step? 65 year old female
More information1.1.2 CPAP therapy is used for patients who are suffering from an acute type 1 respiratory failure (Pa02 <8kPa with a normal or low Pac02).
Guidelines for initiating and managing CPAP (Continuous Positive Airway Pressure) on a general ward. B25/2006 1.Introduction and Who Guideline applies to 1.1.1 This document provides guidance for Healthcare
More informationCondensed 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
More informationKeeping Patients Off the Vent: Bilevel, HFNC, Neither?
Keeping Patients Off the Vent: Bilevel, HFNC, Neither? Robert Kempainen, MD Pulmonary and Critical Care Medicine Hennepin County Medical Center University of Minnesota School of Medicine Objectives Summarize
More informationOXYGEN USE IN PHYSICAL THERAPY PRACTICE. Rebecca H. Crouch, PT,DPT,MS,CCS,FAACVPR
OXYGEN USE IN PHYSICAL THERAPY PRACTICE Rebecca H. Crouch, PT,DPT,MS,CCS,FAACVPR Supplemental Oxygen Advantages British Medical Research Council Clinical Trial Improved survival using oxygen 15 hrs/day
More informationAIRWAY & HEART ANOTOMY
Objectives I CAN T BREATH Respiratory Emergencies Review of anatomical structures related to heart & lungs Differentiate differences between adult and pediatric airways Identify the need for airway assistance
More informationETCO2 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
More informationRespiratory Management in Pediatrics
Respiratory Management in Pediatrics Children s Hospital Omaha Critical Care Transport Sue Holmer RN, C-NPT Objectives Examine the differences between the pediatric and adults airways. Recognize respiratory
More informationStudent Guide Module 4: Pediatric Trauma
Student Guide Module 4: Pediatric Trauma Problem based learning exercise objectives Understand how to manage traumatic injuries in mass casualty events. Discuss the features and the approach to pediatric
More informationCompetency Title: Continuous Positive Airway Pressure
Competency Title: Continuous Positive Airway Pressure Trainee Name: ------------------------------------------------------------- Title: ---------------------------------------------------------------
More informationCapnography (ILS/ALS)
Capnography (ILS/ALS) Clinical Indications: 1. Capnography shall be used as soon as possible in conjunction with any airway management adjunct, including endotracheal, Blind Insertion Airway Devices (BIAD)
More informationMEDICAL KIT - ALGORITHMS
MEDICAL KIT - ALGORITHMS Page 2 : BRONCHOSPASM / ASTHMA Page 3 : TENSION PNEUMOTHORAX Page 4 : Page 5 : Page 6 : CONGESTIVE HEART FAILURE/ PULMONARY EDEMA ANAPHYLACTIC SHOCK / ALLERGIC REACTION ANGINA
More informationNON INVASIVE LIFE SAVERS. Non Invasive Ventilation (NIV)
Table 1. NIV: Mechanisms Of Action Decreases work of breathing Increases functional residual capacity Recruits collapsed alveoli Improves respiratory gas exchange Reverses hypoventilation Maintains upper
More informationSTS: Circulatory/Pulmonary
STS: Circulatory/Pulmonary September 27, 2017 You have a 50 y/o male who is complaining of excruciating pain in his chest. You find him sitting down on a bench, arms in a tripod position, breathing heavily.
More informationSurgery Grand Rounds. Non-invasive Ventilation: A valuable tool. James Cromie, PGY 3 8/24/09
Surgery Grand Rounds Non-invasive Ventilation: A valuable tool James Cromie, PGY 3 8/24/09 History of mechanical ventilation 1930 s: use of iron lung 1940 s: First NIV system (Bellevue Hospital) 1950 s:
More informationRecent Advances in Respiratory Medicine
Recent Advances in Respiratory Medicine Dr. R KUMAR Pulmonologist Non Invasive Ventilation (NIV) NIV Noninvasive ventilation (NIV) refers to the administration of ventilatory support without using an invasive
More informationILS Protocols Content Page
Altered Mental Status/Coma Asthma Chest Pain CPAP Hypoglycemia Intraosseous Infusion (EZ IO) Adult Intraosseous Infusion (EZIO) Pediatric Poisoning and/or Overdose Seizure Spinal Immob. Decision Tree s
More informationACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv
ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv.8.18.18 ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) SUDDEN PROGRESSIVE FORM OF ACUTE RESPIRATORY FAILURE ALVEOLAR CAPILLARY MEMBRANE BECOMES DAMAGED AND MORE
More informationCapnography 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.
More informationyregion I EMERGENCY MEDICAL SERVICES STANDING MEDICAL ORDERS EMT Basic SMO: Airway Management
yregion I EMERGENCY MEDICAL SERVICES STANDING MEDICAL ORDERS EMT Basic SMO: Airway Management Overview: Managing a patient s airway may be necessitated due to upper or lower airway obstruction, inadequate
More informationLearning Objectives. 1. Indications versus contra-indications 2. CPAP versus NiVS 3. Clinical evidence
Learning Objectives 1. Indications versus contra-indications 2. CPAP versus NiVS 3. Clinical evidence Pre-hospital Non-invasive vventilatory support Marc Gillis, MD Imelda Bonheiden Our goal out there
More informationMesa County EMS Protocol Test 2016
Mesa County EMS Protocol Test 2016 1. Which of the following is incorrect? a. Each EMS and Fire agency should have protocols in place for evaluation of personnel involved in fire suppression operations
More informationSTATE OF OKLAHOMA 2014 EMERGENCY MEDICAL SERVICES PROTOCOLS
3K NON-INVASIVE POSITIVE PRESSURE VENTILATION (NIPPV) ADULT EMT EMT-INTERMEDIATE 85 ADVANCED EMT PARAMEDIC Indications: 1. Dyspnea Uncertain Etiology Adult. 2. Dyspnea Asthma Adult. 3. Dyspnea Chronic
More informationBe courteous to your classmates! Please set your cell phones and/or pagers to silent or turn them off.
1 2 EMT OPTIONAL SKILL Naloxone Intranasal Cell Phones and Pagers Be courteous to your classmates! Please set your cell phones and/or pagers to silent or turn them off. 3 4 5 6 Course Outline Introduction
More informationChapter 18. Objectives. Objectives 01/09/2013. Altered Mental Status, Stroke, and Headache
Chapter 18 Altered Mental Status, Stroke, and Headache Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives
More informationObjectives. Health care significance of ARF 9/10/15 TREATMENT OF ACUTE RESPIRATORY FAILURE OF VARIABLE CAUSES: INVASIVE VS. NON- INVASIVE VENTILATION
TREATMENT OF ACUTE RESPIRATORY FAILURE OF VARIABLE CAUSES: INVASIVE VS. NON- INVASIVE VENTILATION Louisa Chika Ikpeama, DNP, CCRN, ACNP-BC Objectives Identify health care significance of acute respiratory
More informationObjectives. Case Presentation. Respiratory Emergencies
Respiratory Emergencies Objectives Describe how to assess airway and breathing, including interpreting information from the PAT and ABCDEs. Differentiate between respiratory distress, respiratory failure,
More informationCase discussion Acute severe asthma during pregnancy. J.G. van der Hoeven
Case discussion Acute severe asthma during pregnancy J.G. van der Hoeven Case (1) 32-year-old female - gravida 3 - para 2 Previous medical history - asthma Pregnant (33 w) Acute onset fever with wheezing
More informationEmergency Medicine High Velocity Nasal Insufflation (Hi-VNI) VAPOTHERM POCKET GUIDE
Emergency Medicine High Velocity Nasal Insufflation (Hi-VNI) VAPOTHERM POCKET GUIDE Indications for Vapotherm High Velocity Nasal Insufflation (Hi-VNI ) administration, the patient should be: Spontaneously
More information1 Chapter 10 Shock 2 Shock Shock: Inadequate State of collapse and failure of the system Leads to inadequate circulation Without adequate blood flow,
1 Chapter 10 Shock 2 Shock Shock: Inadequate State of collapse and failure of the system Leads to inadequate circulation Without adequate blood flow, cannot get rid of metabolic wastes Results in hypoperfusion
More informationRespiratory Emergencies. Chapter 11
Respiratory Emergencies Chapter 11 Respiratory System Anatomy and Function of the Lung Characteristics of Adequate Breathing Normal rate and depth Regular breathing pattern Good breath sounds on both sides
More information10/17/2016 OXYGEN DELIVERY: INDICATIONS AND USE OF EQUIPMENT COURSE OBJECTIVES COMMON CAUSES OF RESPIRATORY FAILURE
OXYGEN DELIVERY: INDICATIONS AND USE OF EQUIPMENT J U L I E Z I M M E R M A N, R N, M S N C L I N I C A L N U R S E S P E C I A L I S T E L O I S A C U T L E R, R R T, B S R C C L I N I C A L / E D U C
More informationMedical NREMT-PTE. NREMT Paramedic Trauma Exam.
Medical NREMT-PTE NREMT Paramedic Trauma Exam https://killexams.com/pass4sure/exam-detail/nremt-pte Question: 41 Which of the following most accurately describes the finding of jugular venous distension
More informationRespiratory Distress/Failure - General
Respiratory Distress/Failure - General Criteria: Dyspnea WITHOUT a clear etiology O 2 V/S and SpO 2 (with and without Oxygen therapy if possible) Blood glucose analysis: if less than 80 mg/dl, refer to
More informationHead Trauma Protocol
Injuries to the head may cause underlying brain tissue damage. Increased intracranial pressure from bleeding or swelling tissue is a common threat after head trauma. Common signs and symptoms of increased
More informationCardiac Emergencies. A Review of Cardiac Compromise. Lawrence L. Lambert
Cardiac Emergencies A Review of Cardiac Compromise Lawrence L. Lambert 1 Cardiac Emergencies Objectives: Following successful completion of this training session, the student should be able to: 1. Describe
More informationIndications for Respiratory Assistance. Sheba Medical Center, ICU Department Nick D Ardenne St George s University of London Tel Hashomer
Indications for Respiratory Assistance Sheba Medical Center, ICU Department Nick D Ardenne St George s University of London Tel Hashomer Respiratory Assistance Non-invasive - Nasal specs - Facemask/ Resevoir
More informationPolytrauma. Same stuff-different day! 9/14/2012. Managing the difficult airway in Multi-Systems Trauma. Jerry J Ryman CRT
Managing the difficult airway in Multi-Systems Trauma Jerry J Ryman CRT Polytrauma More than 1 organ system involved Pulmonary Circulatory Neurological Integumentary Musculo-skeletal Genito-urinary Endocrine
More information3. Identify the importance in the prehospital setting for the administration of nebulized bronchodilator.
TERMINAL OBJECTIVE At the end of this lesson, the EMT-Basic will be able to utilize the assessment findings to formulate a field impression of bronchospasm and understand the administration of nebulized
More informationHome Pulse Oximetry for Infants and Children
Last Review Date: April 21, 2017 Number: MG.MM.DM.12aC2v2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth
More informationAppendix D An unresponsive patient with shallow, gasping breaths at a rate of six per minute requires:
Answer Key Appendix D-2 1. An unresponsive patient with shallow, gasping breaths at a rate of six per minute requires: a. oxygen given via nasal cannula b. immediate transport to a medical facility c.
More informationCHANGES FOR DECEMBER 2008 PREHOSPITAL CARE MANUAL
CHANGES FOR DECEMBER 2008 PREHOSPITAL CARE MANUAL Item Changed Airway Management Procedure Oral Intubation Procedure Tube Confirmation and Monitoring Procedure C10 Chest Pain/ACS M2 Allergic Reaction/Anaphylaxis
More informationApril 2011 CE. Site code # E The Patient With Heart Failure; CPAP as an Intervention
April 2011 CE Site code # 107200E-1211 The Patient With Heart Failure; CPAP as an Intervention Prepared by: Lt. Bill Hoover, Medical Officer Wauconda Fire District Reviewed/revised by Sharon Hopkins, RN,
More informationCapnography: 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
More informationNaloxone Intranasal EMT OPTIONAL SKILL. Cell Phones and Pagers. Course Outline 09/2017
EMT OPTIONAL SKILL Naloxone Intranasal 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
More informationNIV use in ED. Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH
NIV use in ED Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH Outline History & Introduction Overview of NIV application Review of proven uses of NIV History of Ventilation 1940
More informationChapter 21. Objectives. Objectives 01/09/2013. Anaphylactic Reactions
Chapter 21 s Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1. Define key terms introduced in this
More informationWaitin In The Wings. Esophageal/Tracheal Double Lumen Airway (Combitube ) Indications and Use for the Pre-Hospital Provider
Waitin In The Wings Esophageal/Tracheal Double Lumen Airway (Combitube ) Indications and Use for the Pre-Hospital Provider 1 CombiTube Kit General Description The CombiTube is A double-lumen tube with
More informationLecture Notes. Chapter 3: Asthma
Lecture Notes Chapter 3: Asthma Objectives Define asthma and status asthmaticus List the potential causes of asthma attacks Describe the effect of asthma attacks on lung function List the clinical features
More informationBiLevel Pressure Device
PROCEDURE - Page 1 of 7 Purpose Scope Classes/ Goals Define indications and care settings for acute and chronic initiation of Noninvasive Positive Pressure Ventilation. Identify the role of Respiratory
More informationNITROGLYCERIN A NEW LOOK FOR AN OLD FRIEND. Casey Patrick MD Jordan Anderson LP, CCP-C Texas EMS November 19, 2018
NITROGLYCERIN A NEW LOOK FOR AN OLD FRIEND Casey Patrick MD Jordan Anderson LP, CCP-C Texas EMS November 19, 2018 OBJECTIVES Review pathophysiology of CHF Differentiate between acute pulmonary edema (APE),
More informationLesson 4-3: Cardiac Emergencies. CARDIAC EMERGENCIES Angina, AMI, CHF and AED
Lesson 4-3: Cardiac Emergencies CARDIAC EMERGENCIES Angina, AMI, CHF and AED THREE FAMILIAR CARDIAC CONDITIONS Angina Pectoris Acute Myocardial Infarction Congestive Heart Failure ANGINA PECTORIS Chest
More informationINTUBATION/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
More informationOxygen and ABG. Dr Will Dooley
Oxygen and ABG G Dr Will Dooley Oxygen and ABGs Simply in 10 cases Recap of: ABG interpretation Oxygen management Some common concerns A-a gradient Base Excess Anion Gap COPD patients CPAP/BiPAP First
More informationAlgorithm Focus. Emergency Cardiovascular Care: EMT-Intermediate Treatment Algorithms. Perspective regarding the EMT- Intermediate algorithms
Emergency Cardiovascular Care: EMT-Intermediate Treatment Algorithms Algorithms for the Conscious Patient Prehospital Medication Profiles Algorithm Focus Bradycardia Acute Pulmonary Edema and Shock Hypothermia
More informationEMERGENCY MEDICAL SERVICES PROGRAM Policy No April 15, Emergency Medical Services Program. Endotracheal Intubation (ETI)
County of Santa Cruz HEALTH SERVICES AGENCY POST OFFICE BOX 962, 1080 EMELINE AVENUE SANTA CRUZ, CA 95061-0962 (831) 454-4120 FAX: (831) 454-4488 TDD: (831) 454-4123 EMERGENCY MEDICAL SERVICES PROGRAM
More informationBy 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
More informationDefinitions. Definitions. Weaning. Weaning. Disconnection (Discontinuation) Weaning
Definitions 2 Disconnection (Discontinuation) Implies patient no longer needs that form of therapy 80% of patients requiring temporary MVS do not require weaning Definitions 3 Implies some need for MVS
More informationApril 2009 Site Code #107200E-1209 The Patient with Dyspnea
April 2009 Site Code #107200E-1209 The Patient with Dyspnea Prepared by: Bill Hoover, Medical Officer, Wauconda Fire Department Review/revisions by: Sharon Hopkins, RN, BSN, EMT-P To view on the website
More informationI. Subject: Pressure Support Ventilation (PSV) with BiPAP Device/Nasal CPAP
I. Subject: Pressure Support Ventilation (PSV) with BiPAP Device/Nasal CPAP II. Policy: PSV with BiPAP device/nasal CPAP will be initiated upon a physician's order by Respiratory Therapy personnel trained
More informationSEMINOLE COUNTY EMS PROVISIONAL EMT SKILLS VERIFICATION
The following individual has completed the Seminole County EMS Provisional EMT Skills Verification check in the following areas: Oxygen, Airway and Ventilation Skills ALS Assistance Trauma Management Medical
More informationChapter 11. Objectives. Objectives 01/09/2013. Baseline Vital Signs, Monitoring Devices, and History Taking
Chapter 11 Baseline Vital Signs, Monitoring Devices, and History Taking Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights
More informationDo I or Don t I??? Wade Woelfle, MD, FAAEM Assistant Professor Dept. of EM UW Emergency Care Conference 2015
Do I or Don t I??? Wade Woelfle, MD, FAAEM Assistant Professor Dept. of EM UW Emergency Care Conference 2015 ASA 65 yo female CP for 45 minutes radiating to left arm Dyspneic, diaphoretic HR: 95, RR 20,
More informationPediatric Shock. Hypovolemia. Sepsis. Most common cause of pediatric shock Small blood volumes (80cc/kg)
Critical Concepts: Shock Inadequate peripheral perfusion where oxygen delivery does not meet metabolic demand Adult vs Pediatric Shock - Same causes/different frequencies Pediatric Shock Hypovolemia Most
More informationADVANCED 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
More informationLOW FRACTIONAL OXYGEN CONCENTRATION CONTINUOUS POSITIVE AIRWAY PRESSURE IS EFFECTIVE IN THE PREHOSPITAL SETTING
LOW FRACTIONAL OXYGEN CONCENTRATION CONTINUOUS POSITIVE AIRWAY PRESSURE IS EFFECTIVE IN THE PREHOSPITAL SETTING Bryan E. Bledsoe, DO, Eric Anderson, MD, Ryan Hodnick, DO, Larry Johnson, Steven Johnson,
More informationLevel 1: Acute CHF with Hypotension (SBP < 90 torr)
PENNSYLVANIA HOSPITAL ED ACUTE CONGESTIVE HEART FAILURE STANDING DERS Level 1: Acute CHF with Hypotension (SBP < 90 torr) Intake: Vital signs Pulse oximetry Weight Allergies: Obtain old chart Obtain old
More informationNoninvasive ventilation: Selection of patient, interfaces, initiation and weaning
CME article Johnson S, et al: Noninvasive ventilation Noninvasive ventilation: Selection of patient, interfaces, initiation and weaning Saumy Johnson, Ramesh Unnikrishnan * Email: ramesh.unnikrishnan@manipal.edu
More informationPediatric Assessment Triangle
Pediatric Assessment Triangle Katherine Remick, MD, FAAP Associate Medical Director Austin Travis County EMS Pediatric Emergency Medicine Dell Children s Medical Center Objectives 1. Discuss why the Pediatric
More informationResuscitation 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
More informationTest Bank Pilbeam's Mechanical Ventilation Physiological and Clinical Applications 6th Edition Cairo
Instant dowload and all chapters Test Bank Pilbeam's Mechanical Ventilation Physiological and Clinical Applications 6th Edition Cairo https://testbanklab.com/download/test-bank-pilbeams-mechanical-ventilation-physiologicalclinical-applications-6th-edition-cairo/
More informationACUTE HEART FAILURE in the ED. Pr. Samir Nouira Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia
ACUTE HEART FAILURE in the ED Pr. Samir Nouira Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia ACUTE HEART FAILURE 80% Acute Heart Failure Syndrome Sensitivity Specificity
More informationACUTE HEART FAILURE. Julie Gorchynski MD, MSc, FACEP, FAAEM. Department of Emergency Medicine Emergency Residency Program UTHSC, San Antonio TCEP 2014
ACUTE HEART FAILURE Julie Gorchynski MD, MSc, FACEP, FAAEM Department of Emergency Medicine Emergency Residency Program UTHSC, San Antonio TCEP 2014 No disclosures Objectives Overview Cases Current Therapy
More informationITLS Pediatric Provider Course Basic Pre-Test
ITLS Pediatric Provider Course Basic Pre-Test 1. You arrive at the scene of a motor vehicle collision and are directed to evaluate a child who was in one of the vehicles. The patient appears to be a child
More informationIFT1 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
More informationMichigan 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
More informationPALS Pulseless Arrest Algorithm.
PALS Pulseless Arrest Algorithm. Kleinman M E et al. Circulation 2010;122:S876-S908 PALS Bradycardia Algorithm. Kleinman M E et al. Circulation 2010;122:S876-S908 PALS Tachycardia Algorithm. Kleinman M
More informationApproach to type 2 Respiratory Failure
Approach to type 2 Respiratory Failure Changing Nature of NIV Not longer just the traditional COPD patients Increasingly Obesity Neuromuscular Pneumonias 3 fold increase in patients with Ph 7.25 and below
More informationDoubling Down on Nitro is not a Bad Bet. Scott Gilmore, MD, EMT-P, FACEP, FAEMS Medical Director St. Louis Fire Department
Doubling Down on Nitro is not a Bad Bet Scott Gilmore, MD, EMT-P, FACEP, FAEMS Medical Director St. Louis Fire Department What does the asterisk truly mean? EAGLES STAY THIRSTY FOR KNOWLEDGE, my friends
More informationALCO Regulations. Protocol pg. 47
For the EMT-Basic Objectives Understand ALCO regulations relative to monitoring pulse oximetry by the EMT-B Review the signs and symptoms of respiratory compromise. Understand the importance of adequate
More informationAugust 2013 CE. Site code # E-1213
August 2013 CE Site code # 107200E-1213 Caring for the Patient with CHF or COPD Objectives by Reviewed/revised by Sharon Hopkins, RN, BSN, EMT-P To view on the Advocate Condell website visit: www.advocatehealth.com/condell/body.cfm?id=422
More informationAirway and Ventilation. Emergency Medical Response
Airway and Ventilation Lesson 14: Airway and Ventilation You Are the Emergency Medical Responder Your medical emergency response team has been called to the fitness center by building security on a report
More informationChapter 16. Objectives. Objectives. Respiratory Emergencies
Chapter 16 Respiratory Emergencies Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1. Define key
More informationNI 60. Non-invasive ventilation without compromise. Homecare Pneumology Neonatology Anaesthesia. Sleep Diagnostics Service Patient Support
NI 60 Non-invasive ventilation without compromise Homecare Pneumology Neonatology Anaesthesia INTENSIVE CARE VENTILATION Sleep Diagnostics Service Patient Support NI 60 Non-invasive ventilation without
More informationEL DORADO COUNTY EMS AGENCY PREHOSPITAL PROTOCOLS
EL DORADO COUNTY EMS AGENCY PREHOSPITAL PROTOCOLS Effective: July 1, 2017 Reviewed: November 9, 2016 Revised: November 9, 2016 EMS Agency Medical Director ALLERGIC REACTION/ANAPHYLAXIS ADULT BLS TREATMENT
More informationHigh Flow Oxygen Therapy in Acute Respiratory Failure. Laurent Brochard Toronto
High Flow Oxygen Therapy in Acute Respiratory Failure Laurent Brochard Toronto Conflicts of interest Our clinical research laboratory has received research grants for clinical research projects from the
More informationBronchoconstriction is also treated with medications that inhibit bronchiolar constriction such as: Ipratropium (Atrovent)
Patients with difficulty breathing (dyspnea) may have problems with: Oxygenation due to alveolar problems Ventilation due to bronchiolar problems Oxygenation due to lung perfusion problems Combinations
More informationMICHIGAN. State Protocols
MICHIGAN State Protocols Protocol Number 5.1 5.2 5.3 5.4 5.5 Protocol Name Adult Cardiac Table of Contents General Cardiac Arrest Bradycardia Tachycardia Pulmonary Edema/CHF Chest Pain/Acute Coronary Syndrome
More information