EMT Lesson Plans

6.13 Trauma Skills II Station: Increased ICP Instructor Guidance

Objectives: 1. Demonstrate proper emergency medical care of a patient with increased ICP. (p 915) 2. Demonstrate proper emergency medical care of a patient with Cushing’s Syndrome. (p 915) 3. Demonstrate how to immobilize a patient with a suspected spinal injury to a long backboard. (pp 909–911, Skill Drill 26-2) Setup: You will need your cohort bag. You will also need a longboard with accessories. Deploy your students in one team –A student should be patient, the rest rescuers. Have them transition through the scenario on the back of this sheet like any other scenario from a scenario lab day. During the primary assessment, the patient will need BVM ventilation. If they transition into a rapid assessment, tell them that they discover a depressed skull fracture. As the patient gets transported he will begin decorticate posturing. It will be useful to explain what decorticate posturing is to the student so he/she can mimic it convincingly. Debriefing: Give students feedback on the application on the scenario after it is complete. Some points to discuss: - Did they quickly identify the hypoventilation and treat it with an adjunct and BVM ventilation? - Did they identify the blown pupil and the posturing? - Did they identify the bradycardia and hypertension? Do they know that is Cushing’s Syndrome and a sign of ICP? - Did they opt for a nasal airway before they found the bleeding from the left ear? Don’t over-emphasize this contra-indication. PHTLS claims there is no evidence to support this contra-indication – just get them to think about it. - Did they identify the posturing? Did they understand that is related to herniation of the brain into the spinal canal? - They should understand that years ago these patients would get hyperventilated to promote cerebral vasoconstriction. This is NO LONGER recommended as routine practice. They should continue ventilating the patient the standard rate (1/6 seconds). - Elevation of the head may be useful to modestly lower ICP. They can elevate the board in this case. Deployment: DO NOT LECTURE – your students should be working hands-on within 5 minutes of arriving