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Workshop 1-3: Airway/Vitals and SAMPLE, Lifting and Moving/Spinal Immobilization Long Backboard, Spinal Immobilization KED/Hare Traction

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Workshop 1-3: Airway/Vitals and SAMPLE, Lifting and Moving/Spinal Immobilization Long Backboard, Spinal Immobilization KED/Hare Traction Workshop 1-3: Airway/Vitals and SAMPLE, Lifting and Moving/Spinal Immobilization Long Backboard, Spinal Immobilization KED/Hare Traction Airway/Vitals and SAMPLE Equipment Required: suction unit with canister and tubing adult bag valve mask oxygen tank with regulator oral airways nasal airways blood-pressure cuff x2 stethoscope x2 pen light vitals and SAMPLE recording sheets Competencies: Preparatory competencies 4 Must demonstrate the ability to assess a patient for breathing difficulty 5 Must demonstrate ability to acquire a pulse providing rate, rhythm, and strength 6 Must demonstrate ability to assess the skin color, temp, and condition in an adult 7 Must demonstrate ability to assess capillary refill in pt. < 6 yo. 8 Must demonstrate ability to assess the pupils as to equality, size, reactivity 9 Must demonstrate ability to obtain a blood pressure 10 Must demonstrate ability to obtain a SAMPLE history Airway competencies 1 Must demonstrate ability to perform a chin-lift during an airway scenario 3 Must demonstrate ability to perform suctioning during an airway scenario using soft/rigid suction devices 5 Must demonstrate ability to assemble, connect to O2 and ventilate during airway scenario using BVM 6 Must demonstrate ability to ventilate using a BVM for 1 min each demonstration 9 Demonstrate how to insert OP airway during an airway scenario 10 Demonstrate how to insert NP airway during an airway scenario 11 Correctly operate O2 tanks and regulator Airway Proctor guidelines: 1. Have the students practice airway skills using the Airway, Oxygen and Ventilation VPEG. 2. Use the Proctor teaching points below but give the students as much hands-on time as possible. Proctor teaching points: 1. Suctioning equipment Types of Units Mounted Portable – electrical or hand operated Suction Catheters Hard (rigid , tonsil, Yankauer) – preferred for oral suctioning, especially in children Soft – primarily for nasal and ET tube suctioning 2. How to Suction Indications for use- fluids (blood, vomitus) in the throat; gurgling sound is heard when breathing or when performing artificial ventilations Contraindications – none Turn machine on to 200-300 mm Hg Measure suction tubing 3. Oral suctioning –measure same as oral airway 4. Nasal suctioning- measure same as nasal airway 5. Insertion Insert with no suction on the catheter, apply suction and withdraw with a twisting motion Maximum suction time- 15 seconds for adults, 10 seconds for children, 5 seconds for infants 6. Oropharyngeal (oral) Airway Indications for use- unresponsive with no gag reflex Contraindications –gag reflex Measurement- center of mouth to angle of jaw in position of function, or corner of mouth to bottom of earlobe inverted Insertion Adults – inverted, then rotate Infant/child – right side up with tongue depressor 7. Nasopharyngeal (nasal) Airway Indications for use – patient with gag reflex or oral injures unable to maintain airway Contraindications –nasal blockage, basilar skull fracture; a painful stimulus, use only if needed Measurement-tip of nose to ear lobe; also consider diameter Insertion – lubricate, bevel toward septum, attempt right nostril first 8. Assembly of BVM Select appropriate size mask Connect BVM to oxygen source with supply tubing If mask has inflatable collar, ensure collar is properly inflated Turn on oxygen and set flowmeter to at least 15 lpm 9. Positioning the BVM Take position at patients head and open the airway Insert airway adjunct if indicated Apply mask to patients face with the base of the mask in the groove between the lower lip and the chin and the apex over the bridge of the nose If mask has large round cuff surrounding the ventilation port, center the mask over the mouth 10. Hand positioning for two-person operation of BVM- place your thumb over the top half of mask, your index (and middle) fingers over the bottom half, and use your remaining fingers on the jaw to bring the jaw up to the mask; apply firm pressure to maintain an airtight seal; have your partner attach the BVM to the mask and squeeze the bag with two hands until the chest rises adequately 11. Hand positioning for one-person operation of BVM- place the thumb and index finger of one hand to form a "c" around the ventilation port, and use the remaining fingers on the jaw to bring the jaw up to the mask; apply firm pressure to maintain an airtight seal; attach the BVM to the mask and squeeze the bag with the other hand until the chest rises adequately 12. When no trauma is suspected, use the fingers to maintain head position with head tilt chin lift 13. When trauma is suspected, maintain C-spine stabilization and use the fingers to lift the jaw without tilting the head with jaw thrust 14. Ventilating the patient Choose the appropriate rate and observe for adequate chest rise and fall For the patient who is attempting to breathe, coordinate the ventilations with the patient's attempts to breathe Indications for use- patient not breathing or breathing inadequately Contraindications – facial trauma Two person operation more effective; use one person operation as a last resort Vitals and SAMPLE Proctor guidelines: 1. Have the students practice obtaining pulse, blood pressure, and respirations. 2. Discuss with the students how to assess a patient's breathing by looking at the patient as soon as they enter the room of the patient. 3. Have the students practice assessing mental status (AVPU), pupils, and skin color temperature and condition. 4. Have the students practice performing cap refill. 5. Have the students obtain SAMPLE history and OPQRST. 6. Have students record their findings on the Vitals and SAMPLE recording sheets. 7. Use the Proctor teaching points below but give the students as much hands-on time as possible. Proctor teaching points: General 1. Ages for emergency care purposes Infant- 0-1 years of age Child- 1-8 years of age or 1-signs of puberty Adult - >8 years of age or from signs of puberty 2. Baseline vital signs- the initial set of vital signs; consists of blood pressure, pulse, respirations 3. Other vital signs include- skin color temperature and condition, pupils, mental status 4. Other important patient information Chief complaint (CC) - why EMS was called, usually in the patient's words Sample history OPQRST when appropriate Mental status or level of consciousness (LOC) 1. Assessed by observing the patient's level of responsiveness (AVPU) A- Alert V-Verbal P-Pain U-Unresponsive 2. Alert- patient is awake; must determine if they are oriented or disoriented oriented- they know their name, where they are, the time, interacting properly disoriented- do not know some or all of the above, not interacting properly, possibly asking repetitive questions 3. Verbal- patient is not awake but does respond to voice; for ex. You call their name 4. Pain- patient is not awake but does respond to painful stimuli; pinch their shoulders, No Sternal Rubs 5. Unresponsive- does not respond to anything; often loses cough and gag reflex and cannot control their airway 6. Glascow Coma Scale (GCS) is another way to measure mental status and is especially useful for the trauma patient with altered mental status; documented on every patient on patient care reports Pulse 1. Pressure wave as heart contracts 2. Assess initially during primary by palpating the radial or carotid (if not breathing) pulse Use brachial or apical pulse in infants If radial pulse not palpable, assess carotid Never assess carotid on both sides at the same time Avoid excessive pressure on carotid, especially in geriatric patients 3. Rhythm - regular or irregular If irregular, count for a full minute 4. Quality - strong, weak or thready (weak and rapid) 5. Rate – fast, slow, normal 6. Assess during secondary by counting the number of beats in 30 seconds and multiplying by 2 7. Normal resting rates Adult - 60-100/min (athletes and some cardiac meds have lower rate) Child - 80-120/min Infant- 120-140/min Worry if adult <50 or > 120/min Skin color, temperature, condition 1. Measure of perfusion, indication of shock 2. Assessment for color- look at the face, the nail beds, or inside the lips to determine peripheral perfusion to the skin; infants and small children, use palm of hand or sole of foot Normal skin color - pink Abnormal skin colors Pale (white) - poor perfusion Cyanotic (blue-gray) - inadequate oxygenation Flushed (red) - exposure to heat Jaundiced (yellow) - liver abnormalities Mottled (blotchy) - inadequate perfusion, especially in infants and children 3. Assessment for temperature- place back of hand on skin, usually on forehead or cheek Normal skin temperature - warm Abnormal skin temperatures (relative to ambient) Hot - indicating fever or extreme exposure to heat Cool - indicating poor perfusion or exposure to cold Cold - indicating extreme exposure to cold 4. Assessment for condition- place back of hand on skin, usually on forehead or cheek and observe and feel moisture (relative to ambient) Normal skin condition - dry Abnormal skin condition - wet, moist or inappropriately dry 5. Assessment of capillary refill - this sign most reliable in infants and children <6 yo Press on nail beds (palm of hand or sole of foot for infants) and measure the time for pink color to return Room temperature cap refill is normal if pink color returns in <2 sec for infants, children and adult males <3 sec for adult females <4 sec for geriatric patients Room temperature cap refill is delayed if pink color returns in >2 sec for infants, children and adult males >3 sec for adult females >4 sec for geriatric patients Absent for all patients if no pink return or if blue return Cap refill is unreliable in a cold environment and not generally used in patients >6 years old Pupils 1. Evaluates perfusion to the brain 2.
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