2019 EMT Refresher Instructor Manual

v A.2.D - Respiratory Failure 1

A.2.D - Respiratory Failure 2

A.2.D – Choking 1

The patient is 70 year old with an unknown complaint. You find him sitting on his chair responsive only to pain. He is breathing 3 bpm, and is pale and sweaty. The patient will need BVM ventilations and an adjunct. He will not tolerate an oral adjunct. After about 12 breaths, the patient will have gastric distension, but will not vomit. The person who is bagging should be told that bag compliance is poor and that it’s increasing hard to ventilate. The SPO2 will stay at 91%. ALS will arrive and intubate the patient. The person who is bagging should be told that bag compliance is poor and that it is still hard to ventilate. The SPO2 will stay at 91%. ALS will insert an NG tube and the stomach will decompress. The EMT should be told that his effort at ventilation is now easier and the SPO2 has increased to 97%. Critical Criteria Does not open airway manually

The patient is a 50 year old who stabbed in the stomach. A bystander controlled his bleeding, and he is responsive to pain only, and breathing at 34 bpm. He is pale and sweaty. The patient will need BVM ventilations and an adjunct. He will tolerate either adjunct. The patient will continue in this situation for the rest of the scenario. The SPO2 will read “NO READING”.

The patient is 72 year old who is wide-eyed and clutching her throat. Her family insists she is choking on her daughter’s meatloaf. The patient will clutch her throat for another minute until she collapses unresponsive. The patient will expel one object after one round of unconscious obstructed airway maneuvers / CPR, but continue to be obstructed. The patient will expel a second object during the 2 nd round of maneuvers/CPR. The patient will have a brief period of apnea, for which the students must ventilate her. After about 30 seconds of rescue breathing, the patient will become responsive to verbal stimulus and breathe at 14 bpm and transition to a NRB mask. Critical Criteria Does not perform Heimlich maneuver 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 Unable to create visible chest rise Does not connect device to oxygen Does not transition patient to NRB mask Debriefing Points: Were choking maneuvers performed promptly? Why didn’t breaths go in when the object came out? Why was the patient not breathing after the choking was relieved?

Critical Criteria

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

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

Debriefing Points: Were ventilations promptly provided?

What caused this scenario? Why did the SPO2 not read?

Debriefing Points: Why were the ventilations hard to perform? Why didn’t the ET tube help? Why did the stomach decompression help?

A.2.D – Medical Transportation 1

A.2.D – Pediatric Trauma

A.2.D – Respiratory Failure 3

The patient is 24-year-old with a brain tumor that requires 2 lpm of oxygen by nasal canula. The students should set up the canula and SPO2 monitor and transport the patient. Initial SPO2 reading will be 98%. The patient will have a seizure during transport and become apneic. Students should ventilate the patient via BVM and insert an adjunct. The patient will reject the oral airway but tolerate the nasal. If the patient does not get ventilated promptly, make the SPO2 decrease gradually to 80%.

The patient is a 3-year-old who has been hit by a car. The mother tells you he was tossed 10 feet and hit his head on the pavement. There is a large laceration to the head. 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 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.

Critical Criteria

Critical Criteria

Does not open airway manually Opens the airway with head-tilt

Does not appropriately set up oxygen Does not monitor SPO2 Selects inappropriate ventilation device Fails to ventilate at 1 breath / 5-6 seconds

Critical Criteria

Selects inappropriate ventilation device Fails to ventilate at 1 breath / 3-5 seconds Fails to insert adjunct

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

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:

Debriefing Points:

Were ventilations promptly provided? What would other acceptable devices for this scenario include? What caused this scenario?

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?

Were ventilations promptly provided? Were monitoring devices placed before critical care was provided? Discuss the need for spinal precautions in this case.