DOCSLIB.ORG

Respiratory Emergencies 16

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Respiratory Emergencies 16 PART 9 Medicine CHAPTER Respiratory Emergencies 16 The following items provide an overview to the purpose and content of this chapter. The Standard and Competency are from the National EMS Education Standards. STANDARD • Medicine (Content Area: Respiratory) COMPETENCY • Applies fundamental knowledge to provide basic emergency care and transporta- tion based on assessment findings for an acutely ill patient. OBJECTIVES • After reading this chapter, you should be able to: 16-1. Define key terms introduced in this chapter. i. Cystic fibrosis 16-2. Explain the importance of being able to quickly rec- j. Poisonous exposures ognize and treat patients with respiratory emergencies. k. Viral respiratory infections 16-3. Describe the structure and function of the respiratory 16-9. As allowed by your scope of practice, demonstrate system, including: administering or assisting a patient with self- a. Upper airway administration of bronchodilators by metered-dose b. Lower airway inhaler and/or small-volume nebulizer. c. Gas exchange 16-10. Differentiate between short-acting beta2 agonists d. Inspiratory and expiratory centers in the medulla appropriate for prehospital use and respiratory medi- and pons cations that are not intended for emergency use. 16-4. Demonstrate the assessment of breath sounds. 16-11. Describe special considerations in the assessment and 16-5. Describe the characteristics of abnormal breath management of pediatric and geriatric patients with sounds, including: respiratory emergencies, including: a. Wheezing a. Differences in anatomy and physiology b. Rhonchi b. Causes of respiratory emergencies c. Crackles (rales) c. Differences in management 16-6. Explain the relationship between dyspnea and 16-12. Employ an assessment-based approach in order to hypoxia. recognize indications for the following interventions in 16-7. Differentiate respiratory distress, respiratory failure, patients with respiratory complaints/emergencies: and respiratory arrest. a. Establishing an airway 16-8. Describe the pathophysiology by which each of the b. Administration of oxygen following conditions leads to inadequate oxygenation: c. Positive pressure ventilation a. Obstructive pulmonary diseases: emphysema, d. Administration/assistance with self-administration of chronic bronchitis, and asthma an inhaled beta2 agonist b. Pneumonia e. Expedited transport c. Pulmonary embolism f. ALS backup d. Pulmonary edema 16-13. Given a list of patient medications, recognize medica- e. Spontaneous pneumothorax tions that are associated with respiratory disease. f. Hyperventilation syndrome 16-14. Use reassessment to identify responses to treatment g. Epiglottitis and changes in the conditions of patients presenting h. Pertussis with respiratory complaints and emergencies. 445 # 109912 Cust: Pearson Education / NJ / CHET Au: Mistovich Pg. No. 445 C / M / Y / K DESIGN SERVICES OF M16_MIST9137_10_SE_CH16.indd 445 S4CARLISLE 2/28/13 5:27 PM Title: Prehospital Emergency Care 10e Server: Short / Normal Publishing Services KEY TERMS • Page references indicate first major use in this chapter. For complete definitions, see the Glossary at the back of this book. apnea p. 448 hypoxemia p. 448 respiratory distress p. 449 bronchoconstriction p. 449 hypoxia p. 448 respiratory failure p. 449 bronchodilator p. 449 metered-dose inhaler (MDI) p. 464 small-volume nebulizer p. 464 dyspnea p. 448 pulsus paradoxus p. 476 spacer p. 464 hypercarbia p. 449 respiratory arrest p. 450 tripod position p. 472 Case Study The Dispatch As he leads you up narrow stairs to the third floor EMS Unit 106—respond to 1449 Porter Avenue, Apart- of the apartment complex, you scan the scene for ment 322. You have a 31-year-old female patient com- safety hazards and note any obstacles that will make it plaining of respiratory distress. Time out is 1942 hours. difficult to extricate the patient from the building. Upon walking into the apartment, you note a young Upon Arrival woman sitting upright on a kitchen chair, looking very You and your partner arrive at the scene and are greeted scared, and leaning slightly forward with her arms at the curb by the husband of the patient. As you step locked in front of her to hold her up. Before you can out of the ambulance and begin to gather your equip- even introduce yourself, she begins to speak one ment, you ask, “Did you place the call for EMS, sir?” He word at a time with a gasp for breath in between: states very nervously, “Yes. It’s my wife, Anna. She can’t “I—can’t—breathe.” breathe. She really doesn’t look good.” As you and your partner begin walking toward the apartment complex, How would you proceed to assess and care you ask, “What’s your name?” His voice breaks as he for this patient? tells you, “My name is John Sanders. We’ve only been During this chapter you will learn about assessment and married 2 months. Please—you’ve got to help my wife.” emergency care for a patient suffering from respiratory You reply, “John, we’ll take good care of your wife. But, distress. Later, we will return to the case and apply the you’ll help us more if you can calm down.” procedures learned. INTRODUCTION RESPIRATORY ANATOMY, Few things are more frightening to the patient than the PHYSIOLOGY, AND inability to breathe easily, and one of the most common symptoms of a respiratory emergency is shortness of PATHOPHYSIOLOGY breath. A number of other signs and symptoms may ac- The respiratory system can be divided into three por- company difficulty in breathing, which is also known as tions. The first two are the upper and lower airways, respiratory distress. Respiratory conditions may present with the vocal cords (or glottic opening) being the very similarly; this is because many of these findings are transition between the two. The primary purpose of from the body’s attempt to improve breathing adequacy, the upper and lower airways is the conduction of air not necessarily from the specific respiratory condition. into and out of the lungs. The third portion of the As such, many of your treatment modalities are similar respiratory system consists of the lungs and acces- for these conditions. It is important for you to recognize sory structures, which work in concert with the upper the signs and symptoms of respiratory emergencies, and lower airways to allow the oxygenation of body complete a thorough patient interview and physical as- cells and the elimination of carbon dioxide from the sessment to determine the cause, and provide immedi- bloodstream. ate intervention. 446 www.bradybooks.com DESIGN SERVICES OF # 109912 Cust: Pearson Education / NJ / CHET Au: Mistovich Pg. No. 446 C / M / Y / K S4CARLISLE M16_MIST9137_10_SE_CH16.inddTitle: Prehospital 446 Emergency Care 10e Server: Short / Normal Publishing Services 2/28/13 5:27 PM Normal Breathing information to the brainstem to prevent accidental over- expansion injuries, and irritant receptors in the walls Most patients you encounter as an EMT will be breath- of the bronchioles detect the presence of abnormalities ing normally. When referring to normal respiratory such as excessive fluid, toxic fumes or smoke, or signifi- rates, you must remember that normal is defined dif- cant air temperature changes. ferently for each individual patient group based on age Finally, receptors near the alveoli, called juxta- and preexisting disease. For example, a 19 year-old capillary receptors, detect when the alveolar-capillary sitting in a recliner breathing 24 times per minute is beds are becoming abnormally engorged with blood as a fast rate and should raise a concern. However, a re- a result of heart failure. These receptors are believed spiratory rate of 24 per minute in an elderly patient is to play a role in the feeling of shortness of breath the considered to be near the average rate. The following patient may experience, and they may also promote findings are consistent with a patient who is breathing shallow and rapid breathing. adequately: • An intact (open) airway Assessing Breath Sounds • Normal respiratory rate • Normal rise and fall of the chest During the physical exam, auscultation of breath • Normal respiratory rhythm sounds may provide additional evidence of breathing • Breath sounds that are present bilaterally difficulty. The general complaint of breathing difficulty • Chest expansion and relaxation that occurs normally can result from a variety of conditions; therefore, be- • Minimal-to-absent use of accessory muscles to aid in ing able to describe the type of breath sounds may be breathing helpful to medical direction when you ask for a medi- cation order. The following should also occur in a patient who is To achieve the most accurate interpretation of breath breathing adequately, provided that no other condition sounds, it is important to auscultate in the appropriate or injury is involved: fashion. Whenever feasible, have the patient sit upright • Normal mental status and, while using the diaphragm end of your stetho- • Normal muscle tone scope over bare skin (never auscultate over clothing), • Normal pulse oximeter reading (94%) instruct the patient to cough one or two times and then • Normal skin condition findings take deep rhythmic breaths (inhalation and exhalation) with his mouth open. You may need to instruct the pa- tient a few times to make no airway/vocal sounds while Abnormal Breathing he does this. Place the head of the stethoscope on the patient’s thorax, and listen the whole way through the Abnormal factors that are present in certain pulmonary phases of inhalation and exhalation. If necessary, listen (lung) conditions can decrease the efficiency of gas ex- to a few of the patient’s breaths (each breath includ- change across the alveolar-capillary membrane. They ing both inhalation and exhalation) at each auscultation include: location to ensure your interpretation of any abnormal • Increased width of the space between the alveoli and breath sound. Finally, listen to sounds on one location blood vessels of the body, and then listen to the exact location on • Lack of perfusion of the pulmonary capillaries from the other side (mirror location), before moving on.
Load more

Recommended publications
  • ABCDE Approach
    The ABCDE and SAMPLE History Approach Basic Emergency Care Course Objectives • List the hazards that must be considered when approaching an ill or injured person • List the elements to approaching an ill or injured person safely • List the components of the systematic ABCDE approach to emergency patients • Assess an airway • Explain when to use airway devices • Explain when advanced airway management is needed • Assess breathing • Explain when to assist breathing • Assess fluid status (circulation) • Provide appropriate fluid resuscitation • Describe the critical ABCDE actions • List the elements of a SAMPLE history • Perform a relevant SAMPLE history. Essential skills • Assessing ABCDE • Needle-decompression for tension • Cervical spine immobilization pneumothorax • • Full spine immobilization Three-sided dressing for chest wound • • Head-tilt and chin-life/jaw thrust Intravenous (IV) line placement • • Airway suctioning IV fluid resuscitation • • Management of choking Direct pressure/ deep wound packing for haemorrhage control • Recovery position • Tourniquet for haemorrhage control • Nasopharyngeal (NPA) and oropharyngeal • airway (OPA) placement Pelvic binding • • Bag-valve-mask ventilation Wound management • • Skin pinch test Fracture immobilization • • AVPU (alert, voice, pain, unresponsive) Snake bite management assessment • Glucose administration Why the ABCDE approach? • Approach every patient in a systematic way • Recognize life-threatening conditions early • DO most critical interventions first - fix problems before moving on
    [Show full text]
  • Emergency Nursing Program Foreword
    RESOURCE MANUAL NSW HEALTH 2011 Transition to Practice Emergency Nursing Program Foreword The role of emergency nurses requires a broad level of skill and ability to meet the care needs of patients and their families. The Transition to Emergency Nursing Program is designed to support registered nurses new to the practice of emergency nursing. The Emergency Department is a fast-moving environment within which nurses can find themselves faced with a variety of challenges across a day. This program will assist them as they develop their knowledge and skills to meet these often changing care needs within the emergency setting. The program also supports a more consistent approach to transition to emergency nursing and it is anticipated will become the standard for initial entry to practice as an emergency nurse across NSW. This Resource Manual is the core document for the program and is complemented by both the Participant Workbook and the Facilitator’s Manual. Within the Emergency Department participants will be supported by staff to meet the relevant learning objectives during the 3-6 months over which this program extends. The development of the Transition to Emergency Nursing Program has been a lengthy process which reflects the commitment of emergency nurses to their area of practice and I acknowledge and thank them for their enthusiasm and work in enabling the Program to be developed. I am sure that it will have a positive impact for those nurses new to emergency nursing and to the care of patients. 1 Adjunct Professor Debra Thoms Chief Nursing and Midwifery Officer NSW Health NSW Department of Health 73 Miller Street NORTH SYDNEY NSW 2060 Tel.
    [Show full text]
  • Acute on Chronic Neuromuscular Respiratory Failure in the Intensive Care Unit: Optimization of Triage, Ventilation Modes, and Extubation
    Open Access Technical Report DOI: 10.7759/cureus.16297 Acute on Chronic Neuromuscular Respiratory Failure in the Intensive Care Unit: Optimization of Triage, Ventilation Modes, and Extubation Nick M. Murray 1 , Richard J. Reimer 1 , Michelle Cao 2 1. Neurology, Stanford University School of Medicine, Palo Alto, USA 2. Pulmonary and Critical Care, Stanford University School of Medicine, Palo Alto, USA Corresponding author: Nick M. Murray, [email protected] Abstract Critical care management of acute respiratory failure in patients with neuromuscular disease (NMD) such as amyotrophic lateral sclerosis (ALS) is not standardized and is challenging for many critical care specialists. Progressive hypercapnic respiratory failure and ineffective airway clearance are key issues in this patient population. Often at the time of hospital presentation, patients are already supported by home mechanical ventilatory support with noninvasive ventilation (NIV) and an airway clearance regimen. Prognosis is poor once a patient develops acute respiratory failure requiring intubation and invasive mechanical ventilatory support, commonly leading to tracheostomy or palliative-focused care. We focus on this understudied group of patients with ALS without tracheostomy and incorporate existing data to propose a technical approach to the triage and management of acute respiratory failure, primarily for those who require intubation and mechanical ventilatory support for reversible causes, and also for progression of end-stage disease. Optimizing management in this setting improves both quality and quantity of life. Neuromuscular patients with acute respiratory failure require protocolized and personalized triage and treatment. Here, we describe the technical methods used at our single institution. The triage phase incorporates comprehensive evaluation for new etiologies of hypoxia and hypercapnia, which are not initially presumed to be secondary to progression or end-stage neuromuscular respiratory failure.
    [Show full text]
  • Approach to Cyanosis in a Neonate.Pdf
    PedsCases Podcast Scripts This podcast can be accessed at www.pedscases.com, Apple Podcasting, Spotify, or your favourite podcasting app. Approach to Cyanosis in a Neonate Developed by Michelle Fric and Dr. Georgeta Apostol for PedsCases.com. June 29, 2020 Introduction Hello, and welcome to this pedscases podcast on an approach to cyanosis in a neonate. My name is Michelle Fric and I am a fourth-year medical student at the University of Alberta. This podcast was made in collaboration with Dr. Georgeta Apostol, a general pediatrician at the Royal Alexandra Hospital Pediatrics Clinic in Edmonton, Alberta. Cyanosis refers to a bluish discoloration of the skin or mucous membranes and is a common finding in newborns. It is a clinical manifestation of the desaturation of arterial or capillary blood and may indicate serious hemodynamic instability. It is important to have an approach to cyanosis, as it can be your only sign of a life-threatening illness. The goal of this podcast is to develop this approach to a cyanotic newborn with a focus on these can’t miss diagnoses. After listening to this podcast, the learner should be able to: 1. Define cyanosis 2. Assess and recognize a cyanotic infant 3. Develop a differential diagnosis 4. Identify immediate investigations and management for a cyanotic infant Background Cyanosis can be further broken down into peripheral and central cyanosis. It is important to distinguish these as it can help you to formulate a differential diagnosis and identify cases that are life-threatening. Peripheral cyanosis affects the distal extremities resulting in blue color of the hands and feet, while the rest of the body remains pinkish and well perfused.
    [Show full text]
  • Respiratory Mechanics and Breathing Pattern T Jacopo P
    Respiratory Physiology & Neurobiology 261 (2019) 48–54 Contents lists available at ScienceDirect Respiratory Physiology & Neurobiology journal homepage: www.elsevier.com/locate/resphysiol How to breathe? Respiratory mechanics and breathing pattern T Jacopo P. Mortola Department of Physiology, McGill University, 3655 Promenade Sir William Osler, room 1121, Montreal, Quebec, H3G 1Y6, Canada ARTICLE INFO ABSTRACT Keywords: On theoretical grounds any given level of pulmonary or alveolar ventilation can be obtained at various absolute Allometry lung volumes and through many combinations of tidal volume, breathing frequency and inspiratory and ex- Breathing frequency piratory timing. However, inspection of specific cases of newborn and adult mammals at rest indicates thatthe Human infant breathing pattern reflects a principle of economy oriented toward minimal respiratory work. The mechanisms Neonatal respiration that permit optimization of respiratory cost are poorly understood; yet, it is their efficiency and coordination that Work of breathing permits pulmonary ventilation at rest to require only a minimal fraction of resting metabolism. The sensitivity of the breathing pattern to the mechanical properties implies that tidal volume, breathing rate, mean inspiratory flow or other ventilatory parameters cannot be necessarily considered indicators proportional to thecentral neural respiratory ‘drive’. The broad conclusion is that the breathing pattern adopted by newborn and adult mammals is the one that produces the adequate alveolar ventilation
    [Show full text]
  • Slipping Rib Syndrome
    Slipping Rib Syndrome Jackie Dozier, BS Edited by Lisa E McMahon, MD FACS FAAP David M Notrica, MD FACS FAAP Case Presentation AA is a 12 year old female who presented with a 7 month history of right-sided chest/rib pain. She states that the pain was not preceded by trauma and she had never experienced pain like this before. She has been seen in the past by her pediatrician, chiropractor, and sports medicine physician for her pain. In May 2012, she was seen in the ER after having manipulations done on her ribs by a sports medicine physician. Pain at that time was constant throughout the day and kept her from sleeping. However, it was relieved with hydrocodone/acetaminophen in the ER. Case Presentation Over the following months, the pain became progressively worse and then constant. She also developed shortness of breath. She is a swimmer and says she has had difficulty practicing due to the pain and SOB. AA was seen by a pediatric surgeon and scheduled for an interventional pain management service consult for a test injection. Following good temporary relief by local injection, she was scheduled costal cartilage removal to treat her pain. What is Slipping Rib Syndrome? •Slipping Rib Syndrome (SRS) is caused by hypermobility of the anterior ends of the false rib costal cartilages, which leads to slipping of the affected rib under the superior adjacent rib. •SRS an lead to irritation of the intercostal nerve or strain of the muscles surrounding the rib. •SRS is often misdiagnosed and can lead to months or years of unresolved abdominal and/or thoracic pain.
    [Show full text]
  • Signs and Symptoms of COPD
    American Thoracic Society PATIENT EDUCATION | INFORMATION SERIES Signs and Symptoms of COPD Chronic obstructive pulmonary disease (COPD) can cause shortness of breath, tiredness, Short ness of Breath production of mucus, and cough. Many people with COPD develop most if not all, of these signs Avo iding Activities and symptoms. Sho rtness wit of Breath h Man s Why is shortness of breath a symptom of COPD? y Activitie Shortness of breath (or breathlessness) is a common Avoiding symptom of COPD because the obstruction in the A breathing tubes makes it difficult to move air in and ny Activity out of your lungs. This produces a feeling of difficulty breathing (See ATS Patient Information Series fact sheet Shor f B tness o on Breathlessness). Unfortunately, people try to avoid this reath Sitting feeling by becoming less and less active. This plan may or Standing work at first, but in time it leads to a downward spiral of: avoiding activities which leads to getting out of shape or becoming deconditioned, and this can result in even more Is tiredness a symptom of COPD? shortness of breath with activity (see diagram). Tiredness (or fatigue) is a common symptom in COPD. What can I do to treat shortness of breath? Tiredness may discourage you from keeping active, which leads to greater loss of energy, which then leads to more If your shortness of breath is from COPD, you can do several tiredness. When this cycle begins it is sometimes hard to things to control it: break. CLIP AND COPY AND CLIP ■■ Take your medications regularly.
    [Show full text]
  • Sleep Apnea Sleep Apnea
    Health and Safety Guidelines 1 Sleep Apnea Sleep Apnea Normally while sleeping, air is moved at a regular rhythm through the throat and in and out the lungs. When someone has sleep apnea, air movement becomes decreased or stops altogether. Sleep apnea can affect long term health. Types of sleep apnea: 1. Obstructive sleep apnea (narrowing or closure of the throat during sleep) which is seen most commonly, and, 2. Central sleep apnea (the brain is causing a change in breathing control and rhythm) Obstructive sleep apnea (OSA) About 25% of all adults are at risk for sleep apnea of some degree. Men are more commonly affected than women. Other risk factors include: 1. Middle and older age 2. Being overweight 3. Having a small mouth and throat Down syndrome Because of soft tissue and skeletal alterations that lead to upper airway obstruction, people with Down syndrome have an increased risk of obstructive sleep apnea. Statistics show that obstructive sleep apnea occurs in at least 30 to 75% of people with Down syndrome, including those who are not obese. In over half of person’s with Down syndrome whose parents reported no sleep problems, sleep studies showed abnormal results. Sleep apnea causing lowered oxygen levels often contributes to mental impairment. How does obstructive sleep apnea occur? The throat is surrounded by muscles that are active controlling the airway during talking, swallowing and breathing. During sleep, these muscles are much less active. They can fall back into the throat, causing narrowing. In most people this doesn’t affect breathing. However in some the narrowing can cause snoring.
    [Show full text]
  • Review of Systems
    code: GF004 REVIEW OF SYSTEMS First Name Middle Name / MI Last Name Check the box if you are currently experiencing any of the following : General Skin Respiratory Arthritis/Rheumatism Abnormal Pigmentation Any Lung Troubles Back Pain (recurrent) Boils Asthma or Wheezing Bone Fracture Brittle Nails Bronchitis Cancer Dry Skin Chronic or Frequent Cough Diabetes Eczema Difficulty Breathing Foot Pain Frequent infections Pleurisy or Pneumonia Gout Hair/Nail changes Spitting up Blood Headaches/Migraines Hives Trouble Breathing Joint Injury Itching URI (Cold) Now Memory Loss Jaundice None Muscle Weakness Psoriasis Numbness/Tingling Rash Obesity Skin Disease Osteoporosis None Rheumatic Fever Weight Gain/Loss None Cardiovascular Gastrointestinal Eyes - Ears - Nose - Throat/Mouth Awakening in the night smothering Abdominal Pain Blurring Chest Pain or Angina Appetite Changes Double Vision Congestive Heart Failure Black Stools Eye Disease or Injury Cyanosis (blue skin) Bleeding with Bowel Movements Eye Pain/Discharge Difficulty walking two blocks Blood in Vomit Glasses Edema/Swelling of Hands, Feet or Ankles Chrohn’s Disease/Colitis Glaucoma Heart Attacks Constipation Itchy Eyes Heart Murmur Cramping or pain in the Abdomen Vision changes Heart Trouble Difficulty Swallowing Ear Disease High Blood Pressure Diverticulosis Ear Infections Irregular Heartbeat Frequent Diarrhea Ears ringing Pain in legs Gallbladder Disease Hearing problems Palpitations Gas/Bloating Impaired Hearing Poor Circulation Heartburn or Indigestion Chronic Sinus Trouble Shortness
    [Show full text]
  • Respiratory Issues in Rett Syndrome Dr. Marianna Sockrider, Pediatric
    RettEd Q&A: Respiratory Issues in Rett Syndrome Dr. Marianna Sockrider, Pediatric Pulmonologist, Texas Children's Hospital Webcast 02/13/2018 Facilitator: Paige Nues, Rettsyndrome.org Recording link: https://register.gotowebinar.com/recording/1810253924903738120 Attendee Questions Response Breathing Irregularities Why is breathing so funny when our girls/ A behavioral arousal can trigger breathing abnormalities in Rett boys wake up, almost as if startled? syndrome. A person goes through stages of sleep and particularly if aroused from a deep sleep state (REM) may be more disoriented or startled. This can trigger the irregular breathing. Could she address the stereotypical You may observe breathing abnormalities like breath holding breathing abnormalities such as gasping and hyperventilation more with the stress of an acute and breath holding and how they play a respiratory illness. Breath holding and hyperventilation do not part in respiratory illness? directly cause respiratory illness. If a person has difficulty with swallowing and has these breathing episodes while trying to eat or drink, aspiration could occur which can cause respiratory symptoms. If one has very shallow breathing, especially when there is more mucus from acute infection, it may be more likely to build up in the lower lungs causing airway obstruction and atelectasis (collapse of some air sacs). Is there any evidence (even anecdotal) Frequent breath-holding and hyperventilation has been Reference 1 that breathing patterns change in Rett reported to become less evident with increasing age though it is patients over time? not certain whether this could be that families are used to the irregular breathing and don’t report it as much or that it is the people who live longer who are less symptomatic.
    [Show full text]
  • Cert Disaster Medical Operations Guidelines & Treatment Protocol
    WALNUT CREEK, CA COMMUNITY EMERGENCY RESPONSE TEAMS (CERT) CERT DISASTER MEDICAL OPERATIONS GUIDELINES & TREATMENT PROTOCOL TRAINING MANUAL October, 2013 Walnut Creek Community Emergency Response Teams (CERT) Disaster Medical Operations Guidelines & Treatment Protocol Training Manual CERT Disaster Medical Operations (CERT MED OPS) Mission Statement Mission: To provide the greatest good for the greatest number of people. Following a major disaster, CERT volunteers will be called upon to Triage and provide basic first aid care to members of the community that sustain injury of all types and levels of severity. Policy: CERT Medical Operations will function and provide care consistent with national CERT Training guidelines. The CERT Volunteers will function within these guidelines. Structure: CERT Medical Operations (CERT MED OPS) reports to Operations Section. CERT MED OPS Volunteer Requirements CERT MED OPS volunteers will Triage and assess each victim, as needed, according to the RPM & Simple Triage and Rapid Treatment (START) techniques that they learned during CERT training. They will treat airway obstruction, bleeding, and shock by using START techniques. They will treat the victims according to the CERT training guidelines and CERT skills limitations. CERT MED OPS volunteers will also evaluate each victim by conducting a Head-To-Toe Assessment, and perform basic first aid in a safe and sanitary manner. CERT MED OPS volunteers will ensure that victim care is documented so information can be communicated to advanced medical care when and as it becomes available. CERT MED OPS volunteers understand that CPR is not initiated in Disaster Medical Operations e.g., mass casualty disaster situations. The utmost of care and compassion will be undertaken with family members to assist them with their grieving process.
    [Show full text]
  • Hypercapnia in Hemodialysis (HD)
    ISSN: 2692-532X DOI: 10.33552/AUN.2020.01.000508 Annals of Urology & Nephrology Mini Review Copyright © All rights are reserved by David Tovbin Hypercapnia in Hemodialysis (HD) David Tovbin* Department of Nephrology, Emek Medical Center, Israel *Corresponding author: David Tovbin, Department of Nephrology, Emek Medical Received Date: February 04, 2019 Center, Afula, Israel. Published Date: February 14, 2019 Introduction 2 case reports and in our experience with similar patients, BiPAP Acute intra-dialytic exacerbation of hypercapnia in hemodialysis prevented intra-dialytic exacerbation of hypercapnia and possibly (HD) patient has been initially reported 18 years ago [1]. Subsequent respiratory arrest [1,2]. In recent years, new interest was raised similar case was reported few years later [2]. Common features of to HD dialysate bicarbonate concentration. After standardizing to both patients were morbid obesity, a previously stable HD sessions and an acute respiratory infection at time of hypercapnia [1,2]. HD pre-dialysis serum bicarbonate level was recommended as >22 patients with decreased ventilation reserve, due to morbid obesity inflammation malnutrition complex and comorbidities midweek mEq/L [11]. As higher dialysate bicarbonate concentration became with or without obstructive sleep apnea (OSA) and/or obesity more prevalent, a large observation cohort study demonstrated hypoventilation syndrome (OHS) as well as chronic obstructive that high dialysate bicarbonate concentration was associated pulmonary disease (COPD), are at increased risk. COPD is common with worse outcome especially in the more acidotic patients among HD patients but frequently under-diagnosed [3]. Most [12]. However, still not enough attention is paid to HD dialysate COPD patients do well during HD with only mild- moderate pCO2 bicarbonate in the increasing number of patients with impaired increases and slightly decreased pH as compared to non-COPD ventilation, and to their risk of intra-dialytic exacerbation of chronic HD patients [2,4].
    [Show full text]