Paramedic update part 1

TOPIC
1
Workforce Safety and
Wellness

Introduction
• Now more than ever, paramedics
must employ multiple strategies to
ensure their safety:
– Disease transmission
– Recognition of a dangerous scene
– Personal safety
– Health and wellness

Actual Safety Threats
• The leading cause of death to EMS
providers is being involved in a
motor vehicle crash.
• EMS providers are as likely to die
from a heart attack as to be
murdered.
• Leading causes of injury in the EMS
workplace include back injuries and
exposures to bloodborne pathogens.

Responding to the Actual Threats –
Wellness and Injury Prevention
• Motor Vehicle Crashes
– Account for nearly 80 percent of EMS
line-of-duty deaths
– It is imperative to safely operate the
ambulance.
– Seatbelts save lives.
– Seatbelts worn inside the ambulance
can protect the EMS providers.

• Back injuries
– Most common cause of lost work and
long-term disability among EMS
providers
– Proper lifting and moving techniques
should be used in order to prevent
injury

• Key Elements of Proper Lifting
– Anticipate a career of lifting
– Know your limitations and request
assistance when needed
– Lift using the proper power-lift
technique
– Pay attention to minor injuries

• Key Elements of Proper Lifting
– You must set the example and help
build a culture in which lift assistance is
the norm, rather than the exception.
– Know when your capabilities are
outmatched by the weight of your
patient.
– Attempting a lift without proper
capabilities is unsafe to both you and to
your patient.

Infection Control
• Prevent high-risk exposures by using
appropriate personal protective
equipment and using simple
strategies such as:
– Washing your hands
– Handling sharps safely
– Using Standard Precautions

Standard Precautions
• Decide what precautions are needed
as you consider the circumstances.
– Gloves and hand washing are a
minimum.
– Face, gowns, and respiratory
precautions as needed.

• Decide what precautions are needed
as you consider the circumstances.
– Modalities such as IV catheterization,
advanced airway placement, or
medication administration require
additional attention to Standard
Precautions.

• Re-evaluate and choose the
appropriate level of personal
protective equipment accordingly.
• As a paramedic, your decisions will
be setting the example for others.
• It is necessary for a paramedic to
handle sharps safely.

Wellness
• Leading a healthy lifestyle can
benefit paramedics.
• Concepts to incorporate into a
wellness plan include:
– Regular exercise
– Healthy diet
– Rest
– Routine and regular medical care
– Stress management

Stress Management
• Stress can damage your health and
well-being.
• Types of stress reactions include:
– Acute stress reaction
– Delayed stress reaction
– Cumulative stress reaction
• Employ strategies to minimize stress.

Summary
• Self-protection is an imperative part
of safely going home at the end of
the day.
• The paramedic must remain vigilant
to all threats to their well-being.
• Paramedics should take steps to
prevent injury and stay safe and
well.

Introduction
• Many patients die every year as a result
of preventable medical errors.
• As paramedics, you are entrusted to
treat your patients and do no harm.
• Your responsibilities include preventing
medical errors and ensuring the safety
of your patient.
• Improper actions or treatments can
result in harm or death to your patient.

Recognizing Risks
• Scene assessment and situational
awareness can help identify and
avoid problems.
• Patient transfer and handoffs account
for the single largest situation
associated with patient errors.

Patient Transfer and Handoff
You arrive at a busy ED at a time when
your shift has three priority 1 calls
holding. Your suspected stroke patient
seems stable enough, but you are
obviously concerned about the overall
outcome. En route you give a radio
report; on arrival, you recognize the
triage nurse as the person with the
voice you spoke to on the radio.

She says, “Go ahead and put him in
the hall bed; we will be right there.” In
the meantime, dispatch radios you for
the fourth time and asks if you are
available. Having been acknowledged
by the nurse, you and your partner
transfer the patient and leave for the
next call.

• What risks have you exposed the
patient to?
• What consequences can occur
because of your actions?
• How could this have been avoided?

Communication Difficulties
• Miscommunication or communication
difficulties can lead to patient errors.
• Communication difficulties may put
the patient at risk.
• As a paramedic, it is imperative that
you communicate well with others.

Medication Issues
• Incorrect medication administration
can potentially result in disastrous
consequences.
• Ever-changing medication lists,
packaging, and dosage calculations
can all pose potential problems.
• Use the “five Rights” to help reduce
medication errors.

Airway Issues
• Mishandled airways have proven to
be both prevalent and disastrous.
• Misplaced endotracheal intubations
continue to be a serious problem in
the world of EMS.
• Paramedics must incorporate good
airway decision-making skills into the
assessment and management of
each patient.

Patient Movement
• Patients are at risk whenever they
are moved.
• Dropping a patient can lead to injury
and possible legal and civil liabilities.
• Utilize the appropriate resources
and/or technology for safely moving
patients.

Ambulance Crashes
• Ambulance crashes remain the
largest cause of lawsuits against EMS
providers.
• They account for the majority of
injuries to patients by providers.
• Safe ambulance operation is a
responsibility of the paramedic.

Spinal Immobilization
• Proper spinal immobilization is
designed to prevent secondary
injuries.
• When performed inappropriately or
not applied when necessary, it can
present a disastrous risk to the
patient.

How Errors Happen
• Types of errors
– Skill-Based errors
– Knowledge errors
– Rule-based failure
• Each category is potentially
dangerous and can be prevented.

Preventing Errors
• The two main approaches to
preventing errors are systemic
strategies and individual tactics.
• Know your own limitations and
capabilities.
• Seek help when needed.
• Learn from your mistakes.
• Embrace quality improvement and
continuing education.

Introduction
• Legal issues impact every patient
contact.
• Laws are designed to protect both
the patient and the care provider.
• If paramedics do not adhere to the
legislation that they must operate
within, severe legal punishments
may result.

Legal Terms
• Scope of practice
• Negligence
• Intentional torts
• Duty to act
• Ethical behavior
• Medical direction
• Good Samaritan
laws
• Sovereign
immunity
• Statute of
limitations
• Standard of care

Figure 3–1 A paramedic may
be required to testify in court
in a variety of legal settings.

Ethics
• Branch of philosophy directed toward
the study of morals or concepts such
as right or wrong.
• NAEMT has issued a Code of Ethics.
• Ethical decision making should guide
the choices paramedics make
everyday.

Patients’ Rights
• Every patient that summons EMS has
certain “rights.” These include:
– Privacy and confidentiality
– Access to emergency care
– Consent
– Ability to refuse care

Patients’ Rights
• Every patient that summons EMS has
certain “rights.” These include:
– Advance directives
– Organ donation
– Transport
– Privacy
– Refusal

Special Reporting Situations
• EMS providers are legally bound to
report certain types of emergencies.
• These mandatory reporting points
may vary from state to state.
• Paramedics should remain abreast of
what their state requires and learn
the reporting system used.

Summary
• So long as there is EMS, there will be
laws governing EMS.
• The paramedic is solely responsible
for staying abreast of laws that apply
in his state.
• The paramedic should always behave
ethically and act in the best interest
of the patient.

Summary
• The best defense for preventing a
lawsuit is to provide conscientious
care to the patient, maintain the
standard of care, follow state
guidelines, and provide quality
documentation on the patient care
report.

TOPIC
6
Cellular Environment
and Metabolism

Introduction
• Understand how changes in the
patient are due to changes in cellular
integrity.
• The basic intention of emergency
medical care is to keep the cells
alive.
• Cellular integrity must be the core of
a paramedic’s assessment and
treatment.

Physiology
• Metabolism
– Metabolism refers to the sum total of
chemical reactions taking place in the
body.
– Many metabolic activities build upon
each other.
– Disturbances can lead to cellular death,
which in turn ultimately leads to death
of the organism.

Physiology
• Anabolism
– Creation of larger structures from
smaller molecules
– Requires energy
• Catabolism
– Process that breaks down large
molecules into smaller ones
– Requires enzymes and water, and
produces energy in the process

Physiology
• Cellular Respiration
– Process of transferring energy from a
glucose molecule to a cell.
– Oxidation is necessary for energy
production and heat.
– Glucose is the building block of cellular
energy.
– ATP is the primary energy-carrying
molecule.

Physiology
• Aerobic Cellular Metabolism
– Glycolysis
– Citric acid cycle (Krebs cycle)
– Electron transport chain

Figure 6–2 Aerobic metabolism. Glucose broken down in the
presence of oxygen produces a large amount of
energy (ATP).

Physiology
• Anaerobic Cellular Metabolism
– Without oxygen, cellular production of
ATP is very low.
– Glycolysis still occurs.
– Hydrogen molecules build up, increasing
lactic acidosis.
– The cell fails and dies.

Figure 6–3 Anaerobic metabolism. Glucose broken down without the presence of
oxygen produces pyruvic acid, which converts to lactic acid and only a small amount of
energy (ATP). A lack of glucose and oxygen will create a disturbance to cellular
metabolism and may lead to dysfunction and eventual cell death. Cell dysfunction and
death lead to organ dysfunction. When a critical mass of cells dies within an organ, the
organ itself then dies

Physiology
• Sodium/Potassium Pump
– Maintains normal levels of Na+ and K+
on either side of the cellular wall.
– Exchanges three sodium molecules for
two potassium molecules.
– The pump requires ATP to operate.
– If ATP is lacking (anaerobic
metabolism), the pump fails and the cell
ruptures.

Summary
• Understanding the need for normal
cellular function underlies all
branches of medicine.
• Although we tend to treat the
obvious (airway, breathing,
circulation), doing so ultimately
treats the ability to maintain cellular
integrity.

Summary
• Once cells start dying, the syndrome
progresses rapidly and may be
irreversible.
• The paramedic should always
consider how their treatment will
impact cellular activity.

TOPIC
7
Anatomy and Physiology:
The Blood

Introduction
• The blood is the body’s transport
mechanism.
• Understanding the composition and
role of the blood can help the
paramedic understand perfusion,
shock, and the circulatory system in
general.

Composition of the Blood
• Formed elements (45%)
– RBC
– WBC
– Platelets
• Plasma (55%)
– 91 percent water
– Albumin, antibodies, clotting factors

Blood Plasma
• Plasma is the yellow-colored liquid
medium of the blood
– 91 percent water
– -9 percent plasma proteins
• Albumin (maintains the fluid balance in the blood)
• Antibodies (defence against infectious)
• Clotting factors (key in coagulation)

Erythrocytes
• Created during erythropoiesis.
• Eliminated during eryptosis.
• Cytoplasm contains hemoglobin.
• Genesis and elimination of RBCs
provide for maintaining adequate
oxygen-carrying capabilities.

Leukocytes
• Protect the body against infection and
eliminate dead and injured cells and
debris.
• Types of leukocytes
– Neutrophils destruction and removal of bacterial
– Eosinophils deal’swith invaders to the body &
inflamation
– Basophile releases histamine
– Lymphocytes respond to and destroy foreign
invaders
– Monocytes assist antibodies with identifying
unwanted invaders

Thrombocytes
• Platelets are fragments that play a
major role in hemostasis.
• Adhere to each other to form clots
and stop bleeding.

Hemostasis
• Hemostasis is the process of
protecting the circulatory system
from blood loss.
• Phases of hemostasis:
– Vasoconstriction
– Platelet plugging
– Coagulation

Coagulation Cascade
• During coagulation, fibrin is
introduced.
• Fibrin is regulated by chemical
factors and proteins,
• Factor X is activated and initiates a
series of events which cause
coagulation.

Coagulation Cascade
• Prothrombin is converted to
thrombin.
• Thrombin converts fibrinogen to
fibrin fibers which envelope platelet
plug and stabilize the clot.

The Complete Blood Count
• The complete blood count is a test
performed on a sample of blood
• Used to determine the presence of
key elements of blood composition.

Table 7–1 Complete Blood Count Normal Values

Blood Types and Rh Factor
• ABO system categorizes blood based
on the presence or lack of antigens
on red blood cells and antibodies in
plasma.
• Blood types: A, B, AB, and O.
• The Rh factor looks for a specific
third antigen and is represented as
positive or negative

Summary
• Understanding the composition and
role of the blood can help the
paramedic identify, treat, and
manage patients.
• The paramedic should understand
how hemostasis is accomplished.

Objectives
• Identify the major components of the
nervous system.
• Differentiate between the central and
peripheral nervous system and their
roles in maintaining homeostasis.
• Discuss the clinical application of how
the nervous system can affect a
patient’s physiological presentation.

Introduction
• The nervous system allows the body
to:
– Receive information from the
environment
– Transport that information to the brain
– Process and react to the information

Introduction
• Categorized into the central and
peripheral nervous systems.
• Thoughts, movements, senses, and
reflexes are all results of the actions
of the nervous system.

Neurons
• The building blocks of the nervous
system.
• The three types of neurons include
sensory, motor, and interneurons.
• Nerves transmit impulses to convey
information.
• Damage to the nerves can be
detrimental to the body’s natural
function.

Central Nervous System
• Composed of two components.
– The brain
– The spinal cord
• Damage can result in the ability to
perform even basic functions.
• Sensory pathways of the spinal cord:
– Posterior column
– Spinothalamic pathway
– Spinocerebellar pathway

Figure 8–2 The divisions of
the brain.

Peripheral Nervous System
• Composed of structures not covered
by the central nervous system.
• The PNS is divided into two main
sections:
– Somatic division
– Autonomic division
• Sympathetic branch
• Parasympathetic branch

Table 8–1 The Cranial Nerves

The Senses
• Allows the body to relay information
about the environment to the
nervous system.
• Helps prevent the body from
sustaining injuries.

The Senses
• The general senses are:
– Pain
– Temperature
– Touch/pressure/position
– Chemical detection

Special Senses
• The special senses have specialized
organs which relay information.
• The special senses include:
– Sight
– Smell
– Hearing
– Taste

Reflexes
• Reflexes are physiologic responses
from the body to a stimulus.
• Categories of reflexes include:
– Spinal reflexes
– Cranial reflexes
– Somatic
– Autonomic

Summary
• The nervous system is the collector,
transporter, and interpreter for the
world around us.
• A paramedic should understand that
it is vital for maintaining homeostasis
and the ability to move, breathe,
think, and understand the
environment we live in.

Objectives
• Review the components of a medical
term.
• Review a list of common medical
terms.

Introduction
• Medical terminology is the language
of health care.
• By understanding terms,
components, even complex words,
can be broken down.
• Understanding and utilizing proper
terminology can improve
communication between members of
the healthcare team.

Medical Terms Origin
• Terms are often derived from Greek
and Latin sources.
• Common parts compose the terms.
– Prefixes
– Suffixes
– Combining forms
• Some memorization will be required
to get a basic grasp of the language.

Structure of Medical Terms
• Three basic components
– Combining form
• Root
• Combining vowel
– Suffix
– Prefix

How to Define Medical Terms
• Terms can easily be defined by
determining the meaning of their
parts.
• Read left to right, but define by
interpreting the suffix, then the prefix,
then the combining form.
prefix combining form suffix
hyper- glyc/o -emia
(above or excessive) (sugar) (blood condition)

Use proper medical terminology to communicate
with other health care professionals.

Figure 9–1 Sometimes it will be more convenient to
use an accepted medical abbreviation or symbol in your
report instead of writing the entire term.

Table 9–2 Common Prefixes in
Medical Terms

Table 9–2 (continued) Common
Prefixes in Medical Terms

Table 9–3 Common Suffixes in
Medical Terms

Suffixes in Medical Terms

Table 9–4 Common Combining Forms in
Medical Terms

Combining Forms in Medical Terms

Table 9–4 (continued) Common Combining
Forms in Medical Terms

Summary
• The proper use of medical
terminology will help ensure clarity in
the sharing of information regarding
the patient.
• The paramedic should keep abreast
of medical terms and abbreviations
as they pertain to the practice.
• A paramedic is expected to use
proper medical terminology.

TOPIC
11
Self-Defense Mechanisms
and Inflammation

Objectives
• Review the inherent mechanisms of
cellular self-defense and the
inflammatory process.
• Discuss the first-line and second-line
defenses of the inflammatory
response.
• Understand the local and systemic
manifestations of inflammation.

Introduction
• The immune system provides a
defense against the challenges faced
by the body.
• Native immunity includes natural
barriers and inflammation.
• Protective physical, mechanical, and
biochemical barriers provide
protection against infection.

Figure 11–1 The defense
mechanisms of the body.

Figure 11–2 White blood cells form the
basis for the phagocytic response.

The Inflammatory Response
• The inflammatory response is a
complex sequence of events
designed to prevent damage and
repair existing damage to cells.
• It is stimulated by any process that
can kill cells or damage connective
tissue.

Figure 11–3 The process of inflammation.

Manifestations of Inflammation
• Local manifestations of inflammation
include:
– Heat
– Redness
– Swelling
– Pain

• Systemic manifestations of acute
inflammation include:
– Fever
– Leukocytosis
– Plasma protein synthesis

• Acute
– Short time of activation
• Chronic
– Over two weeks of activation
– Common pathways include:
• Persistent accute inflammation
• Neutrophil degranualation and death
• Lymphocyte activation
• Fibroblast activation

Summary
• The immune system provides a
defense against the challenges faced
by the body.
• It is important to understand how
the body responds to theses
challenges, especially at the cellular
level.
• Paramedics should understand how
inflammation impacts the body.

TOPIC
12
The Cardiovascular
System

Objectives
• Distribution of blood within the
vascular compartment and the
physiologic determinants that affect
movement of fluid into and out of the
vascular compartment:
– Hydrostatic pressure.
– Plasma oncotic pressure.

Objectives
• Normal cardiac output, and how certain
variables can alter it from normal:
– Changes in heart rate.
– Changes in stroke volume.
• Systemic vascular resistance, and the
effects should it become deranged:
– Tissue perfusion.
– Systolic and diastolic blood pressure.
– Pulse pressure.

Objectives
• Microcirculation, and how changes of
the aforementioned principles have a
positive or negative effect on it.
• Blood pressure, and how it becomes
deranged from disturbances in the
aforementioned principles.

Objectives
• How the autonomic nervous system
(sympathetic and parasympathetic)
can alter cellular perfusion through
manipulation of the aforementioned
principles.

Introduction
• The heart, the blood, and the blood
vessels each play an essential role in
maintaining adequate tissue
perfusion and homeostasis.
• Understanding how the
cardiovascular system functions will
help the paramedic to recognize
critical situations and anticipate
further patient deterioration.

Blood Volume
• Blood volume is one of the
determinants of adequate blood
pressure and perfusion.
• Blood is distributed throughout the
cardiovascular system.
• Hydrostatic pressure and plasma
oncotic pressure play important roles
in maintaining the fluid balance.

Blood Volume
• Hydrostatic pressure—is the “push” force
inside the vessel or capillary bed generated by
the contraction of the heart and blood
pressure
• Plasma oncotic pressure,colloid oncotic
pressure, or oncotic pressure—is the “pull”
force responsible for keeping fluid inside the
vessels

Table 12–1 Distribution of Blood in the
Cardiovascular System

Figure 12–1 Hydrostatic pressure pushes water out of
the capillary. Plasma oncotic pressure pulls water into
the capillary.

Pump Function of the Myocardium
• The heart must pump effectively to
maintain adequate blood pressure
and perfusion.
• Cardiac output is the amount of
blood ejected by the left ventricle in
1 minute.

Pump Function of the Myocardium
• Systolic blood pressure is a relative
indicator of cardiac output.
• Cardiac output = Heart rate × Stroke
volume

Systemic Vascular Resistance
• The resistance that is offered to
blood flow through a vessel
– Vasodilation typically decreases the
pressure.
– Vasoconstriction typically increases the
pressure.

Systemic Vascular Resistance
• Diastolic pressure is the basic measure of
SVR.
• Pulse pressure is the difference between
the systolic and diastolic blood pressure
readings.
• Vasoconstriction decreases vessel diameter, increases
resistance, and increases blood pressure.
• Vasodilation increases vessel diameter, decreases resistance,
and decreases blood pressure

Microcirculation
• Microcirculation is the flow of blood
through the arterioles, capillaries,
and venules.
• True capillaries are the sites of
exchange between the blood and the
cells.

Microcirculation
• Capillary blood flow is influenced by:
– Local factors
– Neural factors
– Hormonal factors

Microcirculation
• In a resting state, the local factors
predominantly control blood flow through the
capillaries.
• When adaptation is necessary, the neural
factors will change the capillary blood flow.
• Hormones are usually responsible for a
sustained effect on the arterioles and
capillaries.

Microcirculation is the flow of blood through the smallest
blood vessels: arterioles, capillaries, and venules.
Precapillary sphincters control the flow of blood through
the capillaries.

Blood Pressure
• Blood pressure (BP) is derived by
multiplying two major factors:
cardiac output (CO) and systemic
vascular resistance (SVR).
• Blood pressure is monitored and
regulated by:
– Baroreceptors
– Chemoreceptors

Summary
• Maintaining adequate metabolism and
perfusion is essential for the survival of
the cells, organs, and the patient.
• Understanding the ways in which the
cardiovascular system compensates will
help the paramedic not only recognize
critical situations, but also anticipate
further patient deterioration.

TOPIC
15
Medication
Administration

Objectives
• Discuss patient safety strategies
associated with medication
administration.
• Understand the responsibilities of
paramedic-level pharmacology.
• Discuss ways to prevent medication
errors.
• Review nontraditional medication
routes.

Introduction
• Paramedics have access to and
provide a wide array of medications
to benefit patients.
• With this ability, comes great
responsibility.

Introduction
• Paramedics must keep the patient’s
safety at the center of care and
treatment.
• Paramedics must maintain, improve,
and enhance their capabilities to
utilize medications.

Patient Safety
• Patient safety is imperative.
• Medication errors can result in fatal
consequences to the patient.
• Some medication errors encountered
in EMS include those involving:
– Dose
– Route
– Rate of administration
– Allergies

Figure 15–1 Check the
medication.

The Five Rights
• The five rights of medication
administration include:
– Right medicine
– Right dose
– Right time
– Right route
– Right patient

Figure 15–2 Double-check the
concentration and expiration date.

Maintaining Competency
• Paramedics must ensure that their
knowledge base meets and exceeds
the standard of care.
• It is imperative that the paramedic is
familiar with the regulations and
protocols that guide their practice.

Advances in Medication
Administration
• Paramedics have adopted a number
of changes associated with the
delivery of medications.
– Intraosseous administration for adult
and pediatric patients.
– Intranasal administration can allow for
rapid medication absorption and a safer
needle-free environment.

The EZ-IO (Vida-Care Corporation).

Summary
• Medication administration is an
important responsibility of a
paramedic and should always be
taken seriously.
• The paramedic should always
consider the patient’s safety and the
“five rights” before administering any
medication.

TOPIC
16
Paramedic Medications

Objectives
• Review the paramedic formulary.
• Discuss new approaches with
traditional prehospital medications.
• Understand some of the issues
surrounding specific prehospital
medications.

Introduction
• New research has influenced the
medications being administered by
paramedics.
• Paramedics should be aware of
various debates pertaining to the
administration of some medications.
• Paramedics should understand how
these debates may impact their
protocols.

Oxygen Reconsidered
• Hypoxic patients should still receive
oxygen.
• Hyperoxia may be harmful and lead
to systemic vasoconstriction and the
release of free radicals in the body.
• Oxygen therapy should be titrated
based on the monitoring of the
oxyhemoglobin saturation to ≥94
percent.

Figure 16–1 Use of supplemental oxygen is being
reconsidered.

Acute Pulmonary Edema Medications
• Morphine Sulfate
– Morphine has been found to not possess
the vasodilatory property once believed.
– Cardiac toxicity and reduced cardiac
output may occur with administration.
– Low-dose benzodiazepines may provide
the same anxiolytic effects without the
negative side effects.

Acute Pulmonary Edema Medications
• Furosemide (Lasix)
– Once believed that the diuresis would
benefit the patient’s hypervolemic state
and was often administered in high
doses.
– Research studies have found that many
patients in APE are not hypervolemic.
– The diuresis in a normovolemic patient
can lead to hypovolemia, which must be
corrected.

Cardiac Arrest Medications
• The following medications have been
recently reviewed by the AHA and
have remained a cause of much
debate and research with respect to
appropriate care of cardiac arrest:
– Atropine (no therapeutic benefit)
– Vasopressin (no better than standard
EPI)
– Sodium bicarbonate (no benefit)

Other Controversial Medications
• Thiamine
– Thiamine deficiency is rare and for
thiamine to be effective, it should be
administered over days.
• Procainamide
– Antidysrhythmic used in the treatment
of wide complex tachycardia. But avoid
in pt. with a prolonged QT or CHF

Summary (cont'd)
• Paramedics must stay abreast of the
changes and understand how they
can impact their practice.

TOPIC
17
Airway Assessment and
Decision Making

Objectives
• Delineate between respiratory
distress and respiratory failure.
• Review the signs and symptoms that
illustrate ventilatory adequacy of
inadequacy.

Objectives
• Determine when or when not to
ventilate a patient.
• Review and integrate the airway
treatment options for a patient
suffering from a disturbance to the
airway.
• Review core treatment interventions
for a patient suffering from
disturbance to the airway.

Introduction
• Paramedics must be able to properly
assess and recognize airway
dysfunction.
• Airway management is a process
that should be guided by the
assessment findings and should be
goal oriented.

Introduction
• The paramedic must utilize critical
thinking and good decision-making
skills in order to provide the best
treatment for the patient.

Pathophysiology
• Upper airway dysfunction
– Obstruction can result from foreign
bodies or more commonly as a result of
poor muscle tone.
– Structural changes can also impede
airflow.

Loss of control of the upper airway may occur, when the
muscles of the upperairway relax too much and the
epiglottis is allowed to fall back and cover the glottic
opening.

Pathophysiology
• Lower airway dysfunction
– Bronchoconstriction is the most
common cause.
– Other disorders can structurally change
how gas is exchanged in the alveoli.

Airway Assessment
• The paramedic must ensure and
secure the airway.
• Consider the following:
– Mental status, speech, and voice
– Pathophysiology or other findings that
may threaten airway
• Ensure breathing is adequate to
meet the needs of the body

Patient suffering respiratory distress,
indicated by his tripod position.

Respiratory Distress
• Compensation to a respiratory
challenge
– Respiratory rate increases
– Accessory muscles are engaged
– Heart beats faster and stronger
• The compensatory efforts are
sustaining normal function despite
the problem.

Respiratory Failure
• Compensatory mechanisms fail.
– Oxygen may not be distributed
– Carbon dioxide is retained
– Muscles of respiration tire

Respiratory Failure
• The patient will require ventilatory
assistance.
• Altered mental status, hypoxia,
cyanosis, and irregular respiratory
patterns are key findings that
indicate respiratory failure.

The continuum of breathing ranges from normal, adequate
breathing to no breathing at all. It is essential to recognize the
need for assisted ventilations even before severe respiratory
distress develops.

Using Assessment to Guide Treatment
• Quality assessment allows for
recognition of a problem and
provides valuable information.
• Critical thinking is a must for using
the correct tools in the right
circumstance.
• Cost and benefits must be
considered.
• Consider the pathophysiology.

Goals of Airway Management
• Assess the ability to move air and
exchange oxygen and carbon
dioxide.
• Determine weather the patient is in
respiratory distress or respiratory
failure.

Goals of Airway Management
• Goals of airway management should
include:
– Securing and protecting the airway
– Oxygenating the patient
– Ventilating the patient

Outcome-Based Management
• Depends on critical thinking.
• Links assessment findings to desired
outcome in order to form a
treatment plan.
• Allows for the most appropriate tools
for the best patient outcome.

Opening/Securing the Airway
• Basic airway interventions are
frequently the most appropriate to
open and secure the airway.
• Consider both short-term and long-term
airway management.
• Utilize a cost–benefit analysis.
• Consider the nature of the disorder.

Oxygenating and Ventilating
• Ensure adequate oxygenation and
ventilation.
• Patients in respiratory failure require
positive pressure ventilation.
– Consider the ability to secure the airway
– Consider minute volume
– Consider pharmacologic treatments
including oxygen

Oxygenating and Ventilating
• Support compensatory efforts and
reverse the challenge for patients in
respiratory distress.
– Oxygen therapy
– Pharmacologic treatments

Summary
• The paramedic must be able to assess
and promptly treat respiratory failure.
• Airway management should be guided
by the assessment findings and should
be goal oriented.
• Critical thinking is necessary for the
paramedic to choose what is the most
appropriate treatment for their patient.

TOPIC
18
Noninvasive Airway
Intervention

Objectives
• Discuss the core interventions for a
patient suffering from a disturbance to
the airway.
• Review the concepts of oxygen therapy
and positive pressure ventilation.
• Discuss the use of continuous positive
airway pressure during the
management of a patient in respiratory
distress.

Introduction
• Paramedics must use assessment
and critical thinking to decide which
tool is right for a specific patient.
• A wide range of tools are available
for managing patients with airway
problems.
• It is the responsibility of the
paramedic to determine the most
appropriate intervention.

Don’t Forget the Basics
• A paramedic must weigh the costs
and benefits to determine the best
treatment for the patient.
• In many cases, basic interventions
are the most valuable and/or
appropriate.
• Advanced procedures are important
in the right circumstances.

Supplemental Oxygen Revisited
• Oxygen is a drug that must be used
correctly.
• Never withhold oxygen from a
hypoxic patient.
• Continued high-flow oxygen beyond
normal oxygen saturations may
cause hyperoxia.

Supplemental Oxygen Revisited
• Oxygen should be titrated to
maintain a normal saturation levels
of 94 percent to 95 percent

Positive Pressure Revisited
• Positive pressure ventilation is
needed to correct respiratory failure.
• Minimize the effect of positive
pressure on the heart and cardiac
output.
• Keep gastric insufflation in mind.
• Ventilate at age-appropriate rates to
avoid hyperventilation.

Bag-Mask Device and Cardiac Arrest
• Intubation interrupts compressions and
may negatively affect resuscitation.
• Bag-mask ventilations alone may not
be an effective way to move air.
• Blind airway insertion devices should be
considered.
• The costs and benefits of moving to a
more aggressive airway must be
weighed by the paramedic.

Continuous Positive Airway Pressure
• CPAP creates a constant slight flow
of air against which the patient will
breathe.
• CPAP is most commonly used to
treat acute pulmonary edema, but
can be used to treat other forms of
respiratory distress.

Continuous positive airway pressure (CPAP) is used
for the awake and spontaneously breathing patient
who needs ventilatory support.

Summary
• Paramedics must use assessment
findings and critical thinking to
determine the most appropriate way
to manage a patient suffering from
an airway disturbance.

Summary
• Many options are available for the
paramedic to manage the airway.
• Utilizing noninvasive airways may be
the most beneficial for the short-and
long-term outcomes for some
patients.

Paramedic update part 1

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