First Responder Recertification

1. First Responder Recertification
2. Welcome! My name is Laura Glenn • Emergency Medical Call Taker with BCEHS • Professional Responder Instructor • Background in • Athletic Therapy • EMR & PCP Tell me about yourselves • Your name • What brought you here or what do you do for work? • What sport would you compete in if you were to go to the Olympics?
3. Donning and Doffing PPE Donning 1. Wash your hands 2. Put on your gown 3. Put on your mask 4. Put on protective eyewear 5. Put on disposable gloves Doffing 1. Remove disposable gloves 2. Remove your gown 3. Wash your hands 4. Remove protective eyewear 5. Remove your mask 6. Wash your hands Ch 3 – Pg 48
4. Skill Check Donning and Doffing PPE • Gloves
5. Assessment Model • A clear plan of action that will help you to respond effectively • “What are my priorities?” • “What interventions may be necessary?” • These steps, conducted in this order, will increase the chance of a positive outcome Ch 5 – Pg 79-80
6. Scene Survey Ch 5 – Pg 80 and EMALB SOPU Scene Survey (HEMPAG) Hazards • Are there any hazards at the scene? Environment • Where is the emergency located? • How many environmental factors affect the flow of the call? • What is my overall impression with the scene and/or patient? MOI • What happened? (How far did the patient fall? How fast was the car going?) Patients (Number Of) • How many people have been injured? PPE • What PPE should be worn? o Gloves? o Goggles? o Mask? o Gown? Additional Resources • Who else has been dispatched? • Who else do I need with me on this call? o Ambulance? o Fire? o Police? General Impression • What do I see upon approach? • What does the patient look like? o Do I see any massive hemorrhage that requires immediate care? • What is my initial “game plan”?
7. Primary Assessment A rapid systematic check to identify conditions that pose an immediate threat to life. • Assessing LOC • Is there potential for a Delicate Spine? • Simultaneously assessing ABC’s • Performing RBS • Other SOAP BB Ch 5 – Pg 82 and EMALB SOPU
8. Primary Survey Ch 5 – Pg 83 and EMALB SOPU Level of Consciousness (LOC) AVPU • Introduce yourself and obtain consent • Is the patient Alert? • Responsive to Verbal? • Responsive to Pain? • Is the patient Unresponsive? Delicate Spine • Is spinal motion restriction required based on the MOI? • Is there any evidence of trauma to the head/neck/spine? • How does the conscious patient answer, “Did you fall or hit your head or back?”
9. Primary Survey Airway Conscious: • Is the patient talking? Unconscious: • Open with a head-tilt/chin-lift or jaw thrust • Is it clear? • Do I need to suction or roll to clear fluids? • Does the patient need an oropharyngeal airway (OPA) / nasopharyngeal airway (NPA)? Breathing • Assess rate and quality • Perform a simultaneous ABC check if the patient is unconscious (up to 10 seconds) • Assist ventilations if inadequate respirations • Ventilate if respiratory arrest Circulation Conscious = radial pulse Unconscious = carotid pulse Baby = brachial pulse • Perform a simultaneous ABC check if the patient is unconscious (up to 10 seconds) • CPR / AED if the patient is in cardiac arrest Ch 5 – Pg 84-86 and EMALB SOPU
10. Primary Survey Rapid Body Survey • Expose and examine injuries. Perform distal circulation, motor, sensory check (CMS) • Look for medical alerts • Control major bleeds (direct pressure / tourniquet) • Cover open chest wounds • Manually stabilize fractures, then check distal CMS. Realign pulseless limbs (if needed) and apply ice if appropriate • Initiate cooling of burns Other SOAP BB • Check the patient’s Skin for colour, condition, temperature • Apply the SpO2 monitor and assess the patient’s presentation o Is Oxygen needed? § Nasal cannula? § Simple face mask? § Non-rebreather face mask? • Does the patient need an Airway adjunct inserted? • Is your patient in the best Position? o Patients in shock or who are lightheaded should be laid supine; short- of-breath patients often benefit from being positioned in an upright position o Unconscious non-trauma patients are usually best positioned 3/4 prone, etc. • Are there major bleeds or wounds that need to be Bandaged? • Does the patient need a Blanket? Ch 5 – Pg 88-90 and EMALB SOPU
11. Transport Decision Rapid Transport Category (RTC): • Life-threatening conditions • V/S q 5min • If working as a team, one responder can make preparations for transport while the other continues care Non-Rapid Transport Category (Non-RTC): • Stable conditions • V/S q 15min • If the patient’s condition deteriorates, you must re- evaluate • If delaying transport could have a negative effect on the patient’s condition, transport immediately Ch 5 – Pg 89 and EMALB SOPU
12. Skill Check Scene and Primary Assessment Pulse Assessment
13. Secondary Assessment This is usually done on-scene if the patient is stable, and enroute if the patient is unstable (and if the provider is working in a transport-capable capacity). Can reveal injuries or conditions that may become life-threatening. • History / Interview • Vital Signs • Head-To-Toe Examination Ch 5 – Pg 91 and EMALB SOPU
14. Secondary Assessment History / Interview Pain Assessment Signs and Symptoms (also called the chief complaint) Onset Allergies (To what? What happens?) Provoke Medications (Record: name, dosage, frequency, compliance) Quality Past medical history Region/Radiate/Relief Last oral intake Severity (1 to 10) Events (also called history of the chief complaint) Timing Ch 5 – Pg 91-92 and EMALB SOPU
15. Secondary Assessment Vital Signs Aim to complete a set of vital signs within 3 minutes LOC Using AVPU or the Glasgow Coma Scale (GCS) Blood Pressure Palpation or auscultation Heart Rate 15s check x 4 = rater per minute // rhythm // quality Breathing Rate 15s check x 4 = rater per minute // rhythm // quality SpO2 Apply pulse oximeter (if not already done) Skin Colour // condition // temperature Pupils Size // reaction to light // compare both pupils
16. Vital Signs - LOC Ch 5 – Pg 83
17. Vital Signs – Blood Pressure Blood Pressure (BP) • The force exerted by the blood against the blood vessel walls • Created by the pumping action of the heart, in two phases: • Contracting (systole) • Refilling (diastole) Methods Used to Assess BP • Palpation: • Only a blood pressure cuff • Only measures systolic pressure • Auscultation: • Blood pressure cuff and stethoscope • Measures systolic and diastolic pressures Ch 5 – Pg 96-99
18. Vital Signs – Heart Rate Heart Rate (HR) • If the heartbeat changes, so does the pulse • Rate, rhythm, and quality • A well-conditioned athlete may have a pulse of 50bpm or lower • Count for 15sec Ch 5 – Pg 94
19. Vital Signs – Breathing Rate Breathing Rate • A healthy person breathes regularly, quietly, and effortlessly • Rate, rhythm and volume • Try to assess breathing without the patient’s knowledge • Count for 15sec Ch 5 – Pg 94
20. Vital Signs – SpO2 SpO2 • Apply pulse oximeter to support patient assessment • Decide whether the patient requires supplemental O2 based on S&S, C/C and SpO2 Ch 5 – Pg 86-88
21. Vital Signs – Skin Check the patient’s skin for … • Colour: • Normal, red, pink, pale, bluish/cyanotic, etc. • In patients with darker skin, cyanosis may appear ashen- grey, yellow-brown, or greyish-green • Temperature • Hot, warm, cool, cold • Moisture • Dry, clammy, sweaty Ch 5 – Pg 95 and EMALB SOPU
22. Vital Signs – Pupils Pupils • Look closely at size, whether they react to light and are equal size • Check by shading each eye and then allowing light to enter, or by shining a light into each eye Ch 5 – Pg 96-97
23. Head-to-Toe • To gather additional information about injuries or conditions • May not be immediately life- threatening, but they could become so • Balance is necessary: • Ensure that you are palpating effectively • Handle gently to avoid aggravating any existing injuries • Look for abnormalities: • Discolouration • Deformity • Bleeding • Etc. Ch 5 – Pg 100-101
24. Skill Check Secondary Assessment BP Measurement – Palpation BP Measurement - Auscultation
25. Foreign Body Airway Obstruction When an airway is blocked by a foreign object such as food, a small toy, or by fluids such as vomit, blood, mucus, or saliva. Can be either partial or complete. Specific interventions depend on whether the patient is responsive or unresponsive and can also be affected by other factors (if the patient is pregnant, obese, an infant, or in a wheelchair). Ch 6 – Pg 107-108
26. Back Blows Abdominal Thrusts Chest Thrusts Ch 6 – Pg 108-110 Complete Airway Obstruction – Responsive Adult and Child
27. Ch 6 – Pg 111-113 Complete Airway Obstruction – Responsive Infant • Alternate sets of back blows and modified chest thrusts • Preferable to sit or kneel • Even if the infant seems to be breathing well, they should be examined by more advanced medical personnel
28. • 30 chest compressions • Look inside the mouth • If you see an object, carefully remove it • Attempt to ventilate • If breath goes in, give a second breath • If breath does NOT go in, reposition the head • If breath continues to NOT go in, resume 30 chest compressions • Tilting the patient’s head back farther is only necessary on your initial attempt • Attempt only one breath on consecutive cycles Ch 6 – Pg 110 Complete Airway Obstruction – Unresponsive Adult, Child, Infant
29. Complete Airway Obstruction Ch 6 – Pg 111
30. Skill Check Foreign-Body Airway Obstruction Treatment: • Responsive Adult or Child • Responsive Infant
31. Anaphylaxis A life-threatening allergic reaction that causes the air passages to constrict. Ch 6 – Pg 113-114
32. Suspect an allergic reaction if… • There is unusual inflammation or rash after contact with possible allergen • Assess the patient’s airway and breathing • If patient is in respiratory distress or complains throat is closing, you should suspect anaphylaxis Treatment: • Help the patient into the most comfortable position for breathing • Monitor ABC’s • Keep them calm Allergic Reaction / ?Anaphylaxis Ch 6 – Pg 114
33. Treatment for known anaphylaxis: • Use an epinephrine auto-injector • Assist or administer if it is within your scope of practice or covered by medical direction • Because epinephrine does not correct the underlying condition, the patient requires immediate transport to a medical facility Anaphylaxis Ch 6 – Pg 114
34. How to Use an Epinephrine Auto-Injector 1. Check the 6 Rights of Medication (Ch 22 – see next slide) 2. Remove the safety cap 3. Position the injection tip against the patient’s outer thigh and push firmly 4. Hold in place for 10 seconds 5. Rub the injection site for ~30 seconds 6. Ensure the used auto-injector is transported with the patient If a patient does not improve within 5 minutes of the initial dose of epinephrine, further doses may be indicated. Up to three doses may be administered. Oral antihistamines can also help to counteract the effects of the reaction, especially if taken soon after the onset of symptoms. Ch 6 – Pg 114
35. The Six Rights of Medication Quick detour to Ch 22… 1. Right person 2. Right medication 3. Right dosage 4. Right time 5. Right route 6. Right documentation • Time, dose, route, effect Ch 22 – Pg 370-371
36. Respiratory Conditions • Asthma is narrowing and spasming of the muscles lining the bronchi making breathing difficult • Chronic Obstructive Pulmonary Disease (COPD) is a set of conditions characterized by a loss of lung function: • Emphysema • Chronic bronchitis • Bronchospasm Ch 6 – Pg 115
37. Using a Metered Dose Inhaler 1. Check the 6 Rights of Medication 2. Shake inhaler 3-4 times 3. Remove cap • Put inhaler into spacer if available 4. Tell patient to breathe out 5. Have person put the mouthpiece between teeth, then close lips around 6. Tell patient to press top of inhaler once while taking one slow, full breath in • If patient is unable to press top, you may do it instead if the patient asks you to 7. Have patient hold breath as long as comfortable (up to 10 seconds) then exhale Ch 6 – Pg 116-117
38. Skill Check Using an Epinephrine Auto-Injector Using a Meter-Dose Inhaler and a Spacer
39. Airway Adjuncts A tube inserted into patient’s upper airway to assist in keeping it patent. • Especially patients with a DLOR à tongue can cause an anatomical obstruction Remember: • FBAO’s must be cleared before an adjunct can be inserted • Adjuncts may not be sufficient to maintain patency on their own: • You must continue to monitor patient’s respirations and use manual techniques such as HTCL/Jaw Thrust as needed Ch 6 – Pg 131
40. Inserting an OPA - Adult Ch 6 – Pg 131-132 1) Open the patient’s mouth, then insert gently, sliding the tip along the roof of the mouth 2) When the device is 1/2 – 1/3 of the way into the mouth, rotate 180° 3) The OPA should drop into the throat without resistance. The flange should rest on the patient’s lips
41. Inserting an OPA - Child Ch 6 – Pg 132 1) Open the patient’s mouth, then insert gently, sliding the tip along the inside of the cheek 2) When the device is 1/2 – 1/3 of the way into the mouth, rotate 90° 3) The OPA should drop into the throat without resistance. The flange should rest on the patient’s lips
42. Inserting an OPA - Infant Ch 6 – Pg 132-133 1) Hold the tongue against the bottom of the mouth with a tongue depressor 2) Place the OPA against the lower lip with the concave side facing down 3) Slide smoothly into place without rotating, following the natural curvature of the mouth and throat
43. Inserting an NPA Ch 6 – Pg 134 1) Lubricate with a water-soluble lubricant, then insert into the patient’s right nostril, with the bevel towards the septum Remember: • If you feel even minor resistance, do not attempt to force the NPA • If the NPA doesn’t pass easily, remove it and try the other nostril 2) Gently advance the airway straight in (not upward) until the flange rests against the patient’s nostril
44. Suction 1. Measure the distance of insertion (earlobe to corner of mouth) 2. Open the mouth and insert the catheter to the maximum depth just measured 3. Provide rapid suction until airway is clear 4. After, give patient supplemental O2 Ch 6 – Pg 136-137
45. Skill Check Insertion of an OPA Insertion of an NPA Suctioning
46. Oxygen Decision Based on signs and symptoms, chief complaint and SpO2 . Remember: the pulse oximeter is a tool used to support your patient assessment à treat the patient no the tool! Ch 5 – Pg 87-88 Range SpO2 Delivery Device Flow Rate Function Mild Hypoxia 91-94% Nasal Cannula 1-4 LPM Breathing Standard Mask 6-10 LPM Breathing Moderate to Severe Hypoxia < 90% Non-Rebreather Mask (NRB) 10+ LPM Breathing Bag-Valve-Mask (BVM) 15 LPM Non-breathing or abnormal breathing rate (<8 // >30)
47. Skill Check Oxygen Therapy – Set Up and Delivery
48. Assisted Ventilation Technique for delivering atmospheric air and/or O2 into a patient’s lungs when their breathing is inadequate. Indicated for… • Respiratory arrest • Breathing rate <8 • Breathing rate >30 Adult: 1 every 5-6sec Child: 1 every 3-5 sec Infant/Neonate: 1 every 3 sec You should see the patient’s chest begin to rise with each ventilation. Check every 2 minutes whether the patient has begun to breathe spontaneously. Ch 6 – Pg 119-120
49. Bag-Valve-Mask Ch 6 – Pg 123-124
50. Using a BVM Responder A • Positioned at top of patient’s head • Positions mask and opens airway • Maintains a tight seal with the mask • Assess pulse Responder B • Provides ventilations by squeezing the bag • Smoothly • Not forcefully • Just enough for chest to start to rise • Counts rhythm Ch 6 – Pg 123
51. Skill Check Assisted Ventilations – Using a BVM
52. Cardiac Arrest When the heart stops circulating blood. The patient will be… • Unresponsive • Pulseless • Breathless or producing agonal respirations Ch 7 – Pg 147-148
53. Cardiopulmonary Resuscitation To artificially replicate the function of the heart and lungs. Interrupted only to perform critical interventions or obvious changes in the patient’s condition. Adult (8+y/o) Child (1-8y/o) Infant (1-12m/o) Neonate (0-1m/o) Hand Position Two hands on the sternum One or two hands on the sternum Two fingers on the sternum OR encircling method Compression Depth 5cm (~2 in.) 1/3rd of the chest depth One Responder Compressions Continuous chest compressions Two+ Responder Compression Ratio 30:2 15:2 3:1 Compression Rate 100-120 compressions/min (~2/s) Ch 7 – Pg 149-154
54. Ch 7 – Pg 149-154, 162 Cardiopulmonary Resuscitation
55. Quick recap: • 30 chest compressions • Look inside the mouth • If you see an object, carefully remove it • Attempt to ventilate • If breath goes in, give a second breath • If breath does NOT go in, reposition the head • If breath continues to NOT go in, resume 30 chest compressions • Tilting the patient’s head back farther is only necessary on your initial attempt • Attempt only one breath on consecutive cycles Ch 6 – Pg 110 Complete Airway Obstruction – Unresponsive Adult, Child, Infant
56. Using a Defibrillator (AED) A device used to analyze the heart’s rhythm and deliver an electric shock. Only effective on shockable rhythms: • Ventricular tachycardia • Ventricular fibrillation Non-Shockable rhythms: • Normal sinus rhythm • Asystole Deploy immediately in case of cardiac arrest. One responder begins CPR while the second prepares the AED. Ch 7 – Pg 154
57. Defibrillation Precautions • Do not use: • In a moving vehicle • In the presence of flammable materials • If someone is touching the patient • Special situations: • Pregnant person (prop under right hip) • Transdermal medication patches • Implanted pacemakers / cardioverters • Body jewelry • Trauma to the torso • Patients in water • Rain or snow • Child/Infant (small chest) • Neonatal Ch 7 – Pg 155-156
58. Using a Defibrillator Ch 7 – Pg 162
59. Post-Cardiac Arrest Care BLS Field Guide Pg 50
60. Post-Cardiac Arrest Care Return of Spontaneous Circulation (ROSC) • Monitor closely: check pulse regularly • Be prepared to resume CPR: keep pads attached • Return of pulse may not accompanied by resumption of respirations • Provide assisted ventilations • High-flow oxygen Ch 7 – Pg 157
61. Skill Check CPR: Adult / Child / Infant / Neonate Using a Definbrillator
62. Controlling External Bleeding 1. Place patient in seated position 2. Place direct pressure on the wound 3. Apply sterile dressing, applying firm pressure 4. Apply bandage over dressing to maintain pressure 1. If blood soaks through, add additional dressing/bandage 2. Do not remove any blood-soaked dressings/bandages 5. If bleeding continues, apply a tourniquet Ch 9 – Pg 175-176
63. Tourniquets A tight band placed around an extremity to obstruct blood vessels and stop blood flow. Used to treat a hemorrhage when all other interventions are impossible or have been ineffective – only used if absolutely necessary. A bandage and dressing should be used in addition. Ch 9 – Pg 174
64. Tourniquets 1. Apply 5-10cm above the injury (just above any joint in this range) 2. Tighten until the bleeding stops and secure in place 3. Continue to apply direct pressure to wound 4. Document the time it was applied Ch 9 – Pg 174-175
65. Impaled Objects An object that is still in the wound. Larger objects should be left in place unless they interfere with the patient’s airway or respiration: • Stabilize with bulky dressings • Bandage in place to limit movement and control bleeding If the object stops you from caring for a life-threatening condition, it must be removed. Ch 9 – Pg 181
66. Penetrating Chest Injuries Penetration of the chest can injure any structure within the thoracic cavity, including the lungs, heart, and major arteries or veins. The can range in severity from minor to life-threatening. You may hear a sucking sound coming from the wound with each inhalation (ie. a sucking chest wound). Ch 11 – Pg 219-220
67. Your goal is to control any external hemorrhaging without increasing the pressure in the chest • The concern is occluding the wound (air is no longer able to enter or exit) • Occlusion significantly increases the risk of pneumothorax 1. Apply direct pressure with your gloved hand and/or a non-occlusive dressing 2. Monitor the dressing closely and replace saturated dressing immediately to avoid occlusion Ch 11 – Pg 219-220 Penetrating Chest Injuries
68. Abdominal Injuries • Place patient in a supine position • Bend the knees if it does not cause pain and place a rolled blanket or pillow under them • If external bleeding is present, apply trauma dressings and gentle pressure Ch 11 – Pg 221
69. Evisceration 1. Remove clothing from around the wound 2. Cover the area lightly with moist, sterile dressings placed loosely over the wound 3. Cover the dressings loosely with plastic wrap, if available 4. Place a folded towel or blanket over the area • If necessary, gently secure with large bandages Ch 11 – Pg 222
70. Skill Check Controlling External Bleeding Applying a Tourniquet
71. General Care for MSK Injuries RICE Principle: Rest • Avoid unnecessary actions Immobilize • Splint, sling, or bandage Cold • Ice or cold pack Elevate • Helps to reduce swelling Ch 10 – Pg 203-204
72. Types of Splints 1. Soft 2. Rigid 3. Anatomical 4. Traction Ch 10 – Pg 198
73. Types of Splints
74. Splinting Principles • Use appropriate equipment • Splint only if it can be done without causing further injury • Immobilize the joints above and below • Check for normal circulation and sensation before and after • Familiarize yourself with the manufacturer’s directions • Before splinting, cover any open wounds with dressing and bandage • While applying, support the injured body part • Pad the splint Ch 10 – Pg 199-200
75. Sling Regular Sling Tube Sling Ch 10 – Pg 201
76. Simple Rib Fractures • Position the patient to facilitate respiration • Support and immobilize the injured area using a soft, bulky object, such as a pillow or rolled blanket • Provide interventions for respiratory distress or arrest if indicated Ch 11 – Pg 216-217
77. Flail Chest Multiple rib fractures result in a section of the rib cage breaking free (a flail segment) • Leads to paradoxical movement Treatment: 1. Locate the flail segment via palpation 2. Stabilize with bulky dressing that extends beyond the edges of the segment 3. Secure with long strips of tape Ch 11 – Pg 217-218
78. Pelvic Injuries Treatment: • As soon as an injury is suspected, immediately have another responder manually stabilize the area • Avoid putting pressure on the pelvis • Keep the patient supine and avoid movement if possible • If it’s within your training, immobilize the patient Ch 11 – Pg 224-225 and EMALB SOPU When assessing or treating, minimize movement of the pelvis, as any motion increases the risk of damage to internal structures. Only apply steady, downward, gentle movement on the pelvic girdle.
79. Skill Check Splinting Applying a Regular Sling Applying a Tube Sling
80. In-Line Stabilization To bring a patient’s head into neutral alignment: 1. Rotation 2. Side flexion 3. Flexion or extension If you encounter any resistance or the patient complains of pain, stop and immobilize! Ch 12 – Pg 235-236
81. Manual SMR Head Grip Trapezius Squeeze Ch 12 – Pg 236-237
82. Manual SMR Sternal Forehead Grip Modified Trapezius Squeeze Ch 12 – Pg 238-239
83. Applying a Cervical Collar • Ensure the patient’s head in a neutral position and maintain stabilization • Cut away any interfering clothing or jewellery • Draw the patient’s arms gently down towards the waist • Measure the distance between the top of the patient’s trapezius and the bottom of the chin Ch 12 – Pg 238-240
84. Applying a Cervical Collar • Angle the collar for placement and slide the strap end towards the back of the neck • Position the front of the collar beneath the patient’s chin • The chin piece should rest snugly beneath the chin, supporting it gently • The lower position of the collar should be centred and resting on the sternum • Reach carefully behind the neck to grasp the end of the strap and draw it around the back of the neck • Secure the collar with the strap • Visually check to make sure the collar is correctly paced and fitted properly • If the patient is responsive, ensure they can breathe normally • Maintain SMR until the patient is fully secured to a board Ch 12 – Pg 238-240
85. Securing a Patient to a Backboard • Prepare all equipment • Roll the patient onto board • check ABC’s • Apply padding as necessary • check ABC’s • Secure patient to board • Chest • Pelvis • Legs • Head last • check ABC’s Ch 12 – Pg 240-241
86. Skill Check Applying a Cervical Collar Securing a Patient on a Backboard Optional: Helmet Removal Helmet and Shoulder Pad Removal
87. You Did It!