EMT Curriculum

Equipment for this station: - Cohort Bag

- EMT/Airway Manikin or Quality BLS manikin

- Suction Unit

- Pulse Oxymeter or ET3 - CPAP system

Precautions: You should set this up as a mini-scenario with a manikin in the middle and the students holding their equipment around it. DO NOT let this become a verbalization station – they should be doing all activities as they need to develop expertise with the equipment at this point in the class.

SOB 1

SOB 2

SOB 3

SOB 4

The patient is 68 year old with CHF. She is breathing at 22 bpm, with accessory muscle use. The patient will need a NRB mask @ 15lpm and upright positioning. She will SPO2 at 95%. After a minute have the person playing the patient display fatigue, slouching, increased work of breathing, rales and grimacing. If the students do not pick up on the patient’s getting tired, state “your patient appears to be tiring from breathing so hard”. The students should transition her to CPAP. If they do not, the patient will breathe at 6bpm and the SPO2 will drop to 87%. If CPAP is applied early, the patient will maintain an SPO2 of 96% with little effort.

The patient is a 22 year old who has shortness of breath. She states her lips and fingertips are tingling and numb. She states she broke up with her boyfriend yesterday and work up short of breath today. The patient will remain anxious throughout the scenario regardless of treatment. The students can place a NRB or nasal canula on the patient. Regardless of care, the patient will have SPO2 of 100%.

The patient is a 58 year old with chest pains. He is pale, sweaty, and cyanotic around the lips. The patient will continue having chest pains and complain of shortness of breath. He will have SPO2 of 92% off the mask, but 99% on the mask. The patient will suddenly become unresponsive and apneic, but will continue having a pulse as long as he is bagged. He will also need an airway adjunct, and will tolerate either.

The patient is a 22 year old who is wheezing and short of breath. The patient tripoding and working hard to breathe. The patient will require a NRB mask. She will SPO2 @ 94% and not do any better than that. After a minute have the person playing the patient display fatigue, slouching, increased work of breathing, rales and grimacing. If the students do not pick up on the patient’s getting tired, state “your patient appears to be tiring from breathing so hard”. The students should transition her to CPAP. Despite CPAP, this patient will tire and become unresponsive, and breathe at 4bpm. This patient will require BVM ventilations and an airway adjunct. Does not connect device to oxygen Does not identify fatigue in patient Does not transition patient to CPAP Does not identify respiratory failure in patient Does not transition patient to BVM Did not insert airway adjunct Does not apply appropriate monitoring device Debriefing Points: Was NRB and SPO2 applied promptly? What were the signs/symptoms that made the students transition to CPAP? What were the signs/symptoms that made the students transition to BVM? Could the CPAP have been left of to improve the 4bpm’s? Critical Criteria Does not apply NRB mask

Critical Criteria

Critical Criteria

Does not provide oxygen to patient Treats patient with paper bag therapy Does not connect device to oxygen

Does not provide NRB mask Does not monitor SPO2

Selects inappropriate ventilation device Fails to ventilate at 1 breath / 5-6 seconds Fails to insert adjunct

Debriefing Points:

Unable to create visible chest rise Does not connect device to oxygen

Critical Criteria

What are these patient’s symptoms suggestive of? Why provide this patient with oxygen?

Does not apply NRB mask Does not connect device to oxygen Does not identify fatigue in patient Does not transition patient to CPAP Does not apply appropriate monitoring device

Debriefing Points:

Why was the patient placed on a NRB? What caused the patient to collapse and stop breathing?

Debriefing Points:

Was NRB and SPO2 applied promptly? What were the signs/symptoms that made the students transition to CPAP? Could BVM have been used instead of CPAP? Why not wait until SPO2 drops to apply CPAP?