1 June 2009 CE Site code # 107200E-1209 Region X SOP Review ACS, Asystole/PEA, Bradycardia, VF/Pulseless VT, Conscious Sedation, Region X Field Triage Criteria Prepared by: Sharon Hopkins, RN, BSN, EMT-P To view on the website visit: www.condell.org/emsce/
Date of CE presentation: June, 2009 2 Topic: Region x SOP Review: ACS, Asystole/PEA, Bradycardia, VF/Pulseless VT, Conscious Sedation, Region X field Triage Criteria Behavioral Objectives: Upon successful completion of this module, the EMS provider will be able to: 1. Identify the location for V1 V6 electrodes (6 chest electrodes) to obtain a 12 lead EKG. 2. Identify ST elevation when presented with a 12 lead EKG. 3. Identify when Aspirin should be administered for an acute coronary syndrome patient. 4. Identify when Nitroglycerin should be administered for an acute coronary syndrome patient. 5. Identify when Morphine should be administered for an acute coronary syndrome patient. 6. Identify the Region X SOP criteria for treating asystole. 7. Identify the Region X SOP criteria for treating PEA. 8. List the 6 H s and 5 T s that could be causative reasons for cardiac arrest. 9. Identify second degree heat block Type I (Wenckebach), Type II (classical, and third degree (complete). 10. Identify the Region X SOP criteria for treating stable bradycardia. 11. Identify the Region X SOP criteria for treating unstable bradycardia. 12. Identify placement of pads for transcutaneous pacing. 13. Identify the Region X SOP for treatment of ventricular fibrillation and pulseless ventricular tachycardia. 14. Identify the indications and dosing for Lidocaine in the Region X SOP for Conscious Sedation. 15. Identify the indications and dosing for Versed in the Region X SOP for Conscious Sedation. 16. Identify the indications and dosing for Morphine in the Region X SOP for Conscious Sedation. 17. Identify the indications and dosing for Benzocaine in the Region X SOP for Conscious Sedation. 18. Identify the criteria for a Category I trauma patient. 19. Identify transport decisions for a Category I trauma patient. 20. Identify the criteria for a Category II trauma patient. 21. Identify transport decisions for a Category II trauma patient. 22. Actively participate in scenario practice for critical cardiac events. 23. Given a picture, identify ST elevation. References: 1. Aehlert, B. ECG s Made Easy. 3rd Edition. Elsevier. 2006. 2. CMC EMS System February 2009 CE. 12 Lead EKG s. 3. Region X SOP s March 2007, Amended January 1, 2008 4. www.ambulancetechnicianstudy.co.uk 5. www.davidge2.umaryland.edu/~emig/gif/pared2.gif 6. www.emedu.org/ecg/images/ami2b_ia.jpg File: CE, EMS; CE Packets; 2009; June 2009 SOP Review Dept Obj & Ref
3 12 lead EKG Chest Leads Placement starts in the 4 th ICS to the right of the sternum Groups of anatomical Regions on EKG Contiguous Leads Lateral wall I, avl, V5, V6 Inferior wall II, II, avf Septal wall V1 and V2 Anterior wall V3 and V4 ST Elevation Measurement Look 0.04 seconds after the J point J J point is where the QRS complex and ST segment meet ST elevation significant if: > > 1 mm (one small box) above the baseline is noted in 2 or more leads looking at the same anatomical region (contiguous leads) > > 1mm in 2 or more anatomically contiguous chest leads
Where is the ST elevation? 4
Where is the ST elevation? 5
Where is the ST elevation? 6
Where is the ST elevation? 7
Differentiating Heart Blocks 8 There are more P waves than QRS s Is ventricular rhythm regular? YES NO Are PR intervals constant on beats that conduct NO YES Mobitz Type II - Classical NO Do PR intervals get progressively longer until a QRS is dropped? YES NO Are PR intervals variable lengths, with no pattern? YES Mobitz Type I - Wenckebach 3rd degree - Complete Heart block Slide 49
9 Slide 55 Slide 61 SCENARIO #1 There is no pulse
10 SCENARIO #2 The patient has lost consciousness and now has no pulse SCENARIO #2 RHYTHM CHANGE SCENARIO #2 RHYTHM CHANGE
11 SCEANRIO #3 SCENARIO #4
SCENARIO #5 12
Pre-Quiz 13 Paramedic Level For June 2009 CE Material SOP Review Name Date 1. You are on the scene for a patient who complains of chest pain. You are following the Acute Coronary Syndrome protocol. The patient states they took an Aspirin today. What do you do regarding your dose of Aspirin? 2. What should you assess before and after administering nitroglycerin to any patient and why? 3. What side effects should you warn/advise the patient they are most likely to experience after being given a nitroglycerin? 4. What complication is most likely if the patient with ST elevation in II, III, avf (inferior wall MI) is given nitroglycerin? 5. Identify this rhythm strip:
14 6. Identify this rhythm strip: 7. Why is Lidocaine given in conscious sedation and how much? 8. When do you use Amiodarone and when do you use Lidocaine in VF/Pulseless VT? 9. Identify at least 3 criteria for a Category I trauma patient. 10. Identify at least 3 criteria for a Category II trauma patient. File: CE, EMS; CE Packets; 2009; June 2009 Sop Review Pre-quiz