2019 EMT Refresher Instructor Manual

v A.2.C - Respiratory Arrest 1

A.2.C - Respiratory Arrest 2

A.2.C – Choking 1

The patient is an 84-year-old who has collapsed after being confused and having slurred speech for 20 minutes. He has a pulse, but is not breathing. The patient will have a continue having a pulse as long as he is ventilated. Without ventilations the SPO2 will be 84%, but will climb to 96% if ventilated with oxygen. The patient will tolerate an oral airway. Force students to bag with 2- person technique, and to develop timing and hand dexterity.

The patient is a 32-year-old dragged out of a vat at a chemical plant. He was cleaning the vat when the chemical fumes in the container overcame him and he is not apneic. The patient will have a continue having a pulse as long as he is ventilated. Without ventilations the SPO2 will be 68%, but will climb to 93% if ventilated with oxygen. The patient will tolerate an oral airway, but will reject it 2 minutes after being bagged. Force students to bag with 2- person technique, and to develop timing and hand dexterity. The patient will become responsive after a total of 4 minutes of ventilation and only need a NRB mask after that. Selects inappropriate ventilation device Fails to ventilate at 1 breath / 5-6 seconds Fails to insert adjunct Unacceptable adjunct technique Unable to create visible chest rise Does not connect device to oxygen Does not monitor SPO2 Does not provide NRB to responsive patient Debriefing Points: Were ventilations promptly provided? Were monitoring devices placed before critical care was provided? Discuss the significance of aggressive respiratory care in this case The patient is 19 year old who is responsive only to pain and breathing 4 snoring breaths per minute. There is obvious heroin use paraphernalia on the scene and the pupils are pinpoint. The patient will need BVM ventilations and an adjunct. He will not tolerate an oral adjunct. After about 6 breaths, the patient will vomit and require suctioning. ALS will arrive 5 minutes into the scenario and administer Narcan. The patient will vomit again, then begin breathing 22 bpm and begin responding but be confused and agitated. Does not open airway manually Selects inappropriate ventilation device Fails to ventilate at 1 breath / 5-6 seconds Fails to insert adjunct Unacceptable adjunct technique Unable to create visible chest rise Does not connect device to oxygen Does not monitor SPO2 Does not provide NRB to responsive patient Debriefing Points: Were ventilations promptly provided? What caused this scenario? What specific indications were there for Narcan? Critical Criteria Does not open airway manually A.2.C - Respiratory Failure 2 Critical Criteria

The patient is 42 year old who is collapsed. The family thinks he took a heart attack during dinner.

The patient is unresponsive will be obstructed at the first attempt to give breaths. One round of airway maneuvers will remove a large piece of beef from the airway. The patient will then vomit and need suctioning. The patient will then remain apneic and require an airway adjunct and continuous ventilation.

Critical Criteria

Critical Criteria

Does not perform unc FBAO / CPR Places oxygen on patient before clearing airway Fails to identify open airway Fails to ventilate patient @ 1 breath / 5-6 seconds

Does not open airway manually Selects inappropriate ventilation device Fails to ventilate at 1 breath / 5-6 seconds Fails to insert adjunct

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

Unacceptable adjunct technique Unable to create visible chest rise Does not connect device to oxygen Does not monitor SPO2

Debriefing Points:

Were choking maneuvers performed promptly? Why did the patient vomit after the object was relieved? Why was the patient not breathing after the choking was relieved?

Debriefing Points:

Were ventilations promptly provided? Were monitoring devices placed before critical care was provided?

A.2.C - Respiratory Failure 1

A.2.C – Respiratory Failure 3

The patient is an 18 year old who had fallen from a skateboard and is unresponsive.

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

The patient will need BVM ventilations and an adjunct. He will tolerate either adjunct. After about 20 breaths, he will vomit. The patient will need suctioning and resumed ventilation with an adjunct. After about 5 minutes, ALS will arrive and intubate the patient, and ask you to connect him to your ATV so you can help backboard him.

Critical Criteria Opens the airway w, Head Tilt/Chin Lift Selects inappropriate ventilation device Fails to ventilate at 1 breath / 5-6 seconds Fails to insert adjunct

Unacceptable adjunct technique Unable to create visible chest rise Does not connect device to oxygen Does not monitor SPO2

Does not appropriately connect to ATV

Debriefing Points: Were ventilations promptly provided? What caused this scenario? Why not use head-tilt/chin-lift?