Here are the basic steps for using a blood glucometer: 1. Wash hands thoroughly with soap and water. Dry hands completely. 2. Select a finger to prick, usually the side of the finger is best. 3. Insert a test strip into the meter. 4. Prick the side of the finger with a lancing device. Wipe away the first drop of blood. 5. Gently squeeze the side of the finger to obtain a large blood drop. 6. Touch the blood drop to the absorbent tip of the test strip. The meter will automatically start reading the glucose level. 7. Record the blood glucose level reading from the meter display.

1. Emergency Medical Technician to
Emergency Medical Technician
Kansas EMS Scope of Practice Transition Project
1

2. Copyright © 2010, Kansas Board of EMS
All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form without written permission from the copyright
owner or completion of a Kansas Board of EMS approved Train the Trainer program. Additional illustration and photo credits in the support materials of this
document constitute a continuation of this copyright page.
The information in this lesson plan is based on the most current recommendations of responsible medical sources. The Kansas Board of Emergency
Medical Services, the Friesen Group, and all curricula reviewers, however, make no guarantee as to, and assume no responsibility for, the correctness,
sufficiency, or completeness of any information or contents in this program. Local agencies and individuals teaching or participating in this course should
ensure their own safety and operate under the medical oversight of their local physician medical direction or the medical direction of the agency/program
delivering this education.
This material is intended as a guide to facilitate the bridging of existing certified technicians to the new scope of practice in Kansas EMS. It is not intended as
a statement of the standards or absolute practices of care required in any particular situation. Circumstances and the patient's condition can and will vary
widely from one situation to another. This course material does not represent or advise emergency medical personnel of any legal authority to perform the
activities or procedures discussed in this material. Legal authority and permission to practice emergency medical care must be determined at the local level.
All patients and providers described in this material are fictitious.
2

3. Module 1: Airway and Breathing
Module 2: Assessment
Module 3: Pharmacological Interventions
Module 4: Emergency Trauma Care
Module 5: Emergency Medical Care
3

4. Module 1: Airway and Breathing
4

5. • Small volume nebulizer are devices that contain a small chamber for fluid based
medications to be placed. By flowing oxygen or air through the chamber at a
sufficient rate, the fluid medication is aerosolized into a vapor mist that can be
administered to the patient as they breath.
• Before beginning the administration of medication through a small volume
nebulizer, ensure that appropriate (BSI) are in place and utilized.
• While the equipment that you will be using is not expected to remain sterile, it
is important that you keep it clean. Replace any contaminated items.
• Reasons why small volume nebulizers may be used?
Used in bronchial asthma and other reversable bronchospasm that is associated
with chronic bronchitis and emphysema.
Small Volume Nebulizer
5

6. • During treatment have the patient
breath in deeply if tolerated.
• Some patients may want to hold the
nebulizer. If so let them.
• Repeat dosages. Check local protocols.
Nebulizer
6

7. * Some patients
such as the Elderly
and Children may
benefit with the use
of a facemask when
using a nebulizer
Nebulizer With Mask
7

8. • BSI percautions
• Physical Exam / History
• Vitals
• Oxygen if needed
• Obtain need for Nebulized treatment
• Standing orders or online medical direction
• 5 rights (Patient, Medication, Dose, Route, Time.
• Assemble Kit
• Add medication
• Connect Oxygen
• Flow rate 6 - 8 LPM for 5 – 10 minutes.
• Repeat Exam / Vitals
Small Volume Nebulizer
8

9. * If the tidal volume (normal inspiration/ventilation) is to low or
respiratory rate is to slow. You may need to use a nebulizer with
BVM. Check local protocols.
BVM with Nebulizer
9

10. • BSI precautions
• Provide oxygen
• Perform history / exam
• Vitals
• Standing orders, online medical control
• Gather necessary equipment Oxygen, Nebulizer
kit, BVM, Medication
• Medication expiration
• 5 rights
• Assemble kit to BVM add medication
• Connect O2 to BVM 15 LPM.
• Connect O2 to Nebulizer 6-8 LPM.
• Ventilate 8-10 times a minute
BVM with Small Volume Nebulizer
10

11. 11

12. Infant Adult/Child
1
1
2
2
12

13. The EMT must always be able to
Visualize
the entire forceps.
13

14. 1. BSI precautions
2. Identify choking patient
3. Follow BLS guidelines
4. Conscious Adults and Children receive abdominal thrusts
5. Unconscious Adults and Children receive chest thrusts
6. Infants receive back blows and chest thrusts
7. Grasp magills
8. Open mouth
9. Insert magills
10. Suction
11. Reassess patient
12. Provide Interventions
Magill’s Forceps
14

15. Manually Triggered Ventilator
15

16. Mouth-to-mask
Two person bag-valve-mask
One-person bag-valve-mask
Mouth to Mouth without a barrier device
16

17. Indications . . .
Contraindications
&
Complications
of the MTV
17

18. Manually Triggered Ventilator
18

19. 19

20. Depth
and
Rate
20

21. Indications . . .
Contraindications
&
Complications
of the Automatic Transport Ventilator
21

22. SEE SKILL SHEET
Automatic Transport Ventilator
22

23. Gastric
Decompression
23

24. Initial steps in the management of
Gastric Distention
Reposition Airway Cricoid Pressure Ventilate Slowly
24

25. Reposition Airway
A poor airway promotes gastric distention
25

26. Cricoid Pressure
Closes off the esophagus and
routes air to lungs
26

27. Ventilate Slowly
27

28. Manual
Decompre ssion
of the stomach
28

29. Gastric Tubes
29

30. EMT Use of Gastric Tubes
OG NG
30

31. Indication: Contraindication:
*Gastric destintion is present and *Caution in esophageal disease or
interfering with ventilations. esophageal traum.
*When patients will be ventilated *Facial trauma.
for long period of time. *Esophageal obstruction.
NG TUBES
Paramedic use only!
Advantages: Disadvantages:
*Tolerated by alert patients. *Uncomfortable for patients.
*Doesn’t interfere with intubation. *May cause patient to vomit.
*Mitigates recurrent gastric *Interfere with BVM,MTV,ATV.
distention.
*Patient can still talk.
Complications: Nasal gastric trauma from poor technique. ET placement.
31

32. Indication: Contraindication:
*Threat of aspiration. *Caution in esophageal disease or
*Need to decrease pressure of the esophageal trauma.
stomach on the diaphram. *Esophageal obstruction.
*Patient is unconscious.
OG TUBES
EMT is allowed to use this device.
Advantages: Disadvantages:
*May use larger tubes. *Uncomfortable for conscious patients.
*Safer to insert in patients with facial *May cause retching and vomiting with
Fractures. patients that have intact gag reflex.
*Lower risk of nasal bleeding.
Complications: Patient may bite the tube. 32

33. Not all supraglottic airways allow for the insertion of gastric tubes. The airways
that do so include:
*Combitube
*King Airway
*Esophageal Gastric Tube Airway
*Laryngeal Mask Airway
Once the EMT has taken care of the ABC’s, they will develop and idea of whether
there is a threat from gastric distention. Threats that indicate the need for gastric
decompression.
*Inability to adequatley ventilate due to increased lung resistance.
*Vomiting.
Orogastric Tubes
33

34. CO2 Monitoring/Caponography:
*The amount of end tidal CO2 is an accurate indicator of the ability
of the patient to exchange O2 for CO2 at the alveoli/capillary level.
EMT’s can use this tool as a mechanism to assess the placement of
airway devices as well as to guide them in the provisions of effective
CPR.
End-Tidal
CO2 Monitoring
34

35. Colorimetric devices use a chemically treated paper that
responds to the level of CO2 in the air that interacts with
the paper in the colorimetric device. The higher the CO2
level, the more color change.
Colorimetric Device
35

36. Capnograph
36

37. Exhaled Air Flow
Legend
Litmus Paper
37

38. Capnometer allows EMT’s to assess.
*Airway placement.
*Dislodgement of ET tube.
*Effectiveness of CPR.
*Spontaneous circulation (ROSC).
*Efficacy of breathing treatments.
Detector
Read-out
38

39. Waveform Components A-B is the inspiration/dead space marker
B-C is the exhalation upstroke
C-D is the continuation of exhalation
D is the end tidal value (peak)
D-E is the inspiration washout
39

40. *A-B is the inspiration/dead space exhalation marker.
CO *B-C is the exhalation upstroke where gases from lungs are detected.
2 *C-D is the continuation of exhalation.
*D is the end tidal value where peak CO2 is found
Normal Waveform
*Efficacy of breathing treatments.
d
c
a b e
Time
40

41. Poor Waveform CO2
d
c
a b e
Time
41

42. Numeric Readouts
Waveform Display
42

43. Airway Placement
Confirmation
using End-Tidal CO2
The supraglottic airways placed by EMT’s are generally built such that they may be used in
either the trachea or esophogus. The EMT must know in which location the tube is placed
and ventilate appropriatley with the device. Using some form of end tidal CO2 monitoring
allows the EMT to guage the effectiveness of the airway based off the amount of CO2
return.
43

44. Ensuring adequate
Ventilations
using End-Tidal CO2
The EMT can use the end tidal CO2 readings as a mechanism to avoid hyperventilation or
hypoventilation of the patient.
44

45. Early indication of
using End-Tidal CO2
45

46. EtCO2
24
EtCO2
Early indication of 20
INEFFECTIVE
Effectiveness of CPR:
1. End tidal CO2 measure to assist in ventilation. Compressions
EtCO2
a. Target value normal range 35-45 ETCO2.
b. Hyperventilation the number will fall.
16
c. Hypoventilation the number will rise.
2. End tidal CO2 measure to assist in compressions
EtCO2
a. Correlation with ETCO2 dropping ineffective CPR.
b. Switching rescuers should result in increase
12
ETCO2.
46

47. 47

48. End-Tidal CO2 Monitoring
48

49. Pulse Oximetry
49

50. Light
LED Detector
How Pulse Oximetry Works
50

51. Equal to or greater than
What is normal?
51

52. 52

53. Pulse Oximeter
53

54. Scene Size Up (No Pulse Oximetry)
Initial Assessment (May include use of the pulse oximeter)
1. Airway
2. Breathing (Observe, Estimate, Listen, Oximeter)
3. Circulation
4. Disability (LOC)
5. Expose and Examine
History and Physical Assessment (Pulse oximeter)
Detailed Assessment (Pulse oximetry)
On-Going Assessment (Pulse oximetry)
Assessing Results
54

55. > 95 % “Normal”
91% - 94% Mild hypoxia.
86% - 90% Moderate hypoxia.
< 85% Severe hypoxia.
(Bledsoe, Porter & Cherry, 2007, 463)
Assessing Results
55

56. 56

57. Assess and treat patient, not the oximeter
Never withhold oxygen if S/S of hypoxia or
hypoxemia are present – regardless of the
reading on the oximeter
Pulse oximeters measure saturation of the
hemoglobin, not oxygenation or ventilation.
Oximetry – 3 Basic Rules
57

58. 58

59. Pulse Oximetry
59

60. Module 2: Assessment
60

61. 61

62. 62

63. One of the key concerns has been reliability of the non-invasive measurement as
compared to manual auscultation. Rule of thumb. When you find a NIBP reading out of
normal range for the context of your patient, double check it with a manual BP.
Appropriate cuff should cover 2/3 of the upper arm.
HAVE THE STUDENTS USE THE FORMULARY OVER THE MEDICATIONS TO STUDY AND FILL
IN THE WORK BOOK AFTER THIS CLASS IS OVER. HAVE THEM TAKE IT HOME. SO NEXT
CLASS CAN TAKE TEST, ASK QUESTIONS, FOCUSE MORE ON THE SKILL.
Non-Invasive Blood Pressure Monitoring
63

64. Module 3: Pharmacological Intervention
64

65. Why
Medications?
See EMR transition media for the Five rights. Use EMT pages 66-73
for the medication formulary.
65

66. Rights
66

67. Right
Medication
67

68. Right
Patient
68

69. Right
Dose
69

70. Right
Route
70

71. Right
Time
71

72. INHALATION
EMT Medication Routes
72

73. Forms of Medication
73

74. EMT Medication
Sc pe
74

75. Albuterol Sulfate
75

76. Aspirin
76

77. 77

78. 78

79. Glucagon
Auto-Injector
(Soon Available)
© Enject
79

80. 80

81. 81

82. Mark 1 or Duodote Kit
82

83. Mark 1 Kit
1 2
3 4 5
6 7 8
83

84. 84

85. Setting the Stage for the
Administration
of Medication
85

86. Medication Administration
86

87. Module 4: Emergency Trauma Care
87

88. Pelvic Wrap
Splint
Any pelvic fracture is at risk for significant blood loss and the emt must stabalize the
fracture appropriatley.
Pelvic fractures can be splinted in a number of ways.
*PASG
*Sheet wrap
*Inverted KED
*Commercial pelvic splint
88

89. 89

90. 90

91. 91

92. PASG:
*When using this as a splinting device, the EMT should apply the device and inflate it only
enough to provide stabilization. When using the device, it is best placed on a long spine
board before the patient is log rolled. The device is fastened around the patient and
inflated to allow for immobilization.
Sheet Wrap:
*When using a sheet wrap the procedure is straight forward.
1. Take a cloth and fold it into a 8” wide, flat band.
2. Center it under the buttocks so that when wrapped it will cover the greater
trochanters.
3. Wrap the sheet across the symphysis pupis and tie with a half knot.
4. Tighten it to stabilize the pelvis.
5. Secure with safety pins.
6. Move patient to LSB.
KED:
Invert the KED use the body portion to secure the pelvic region. Move to LSB.
Pelvic Splinting
92

93. Module 5: Emergency Medical Care
93

94. 94

95. RA
- - I +
-
LA
II III
+ +
LL
Ground
95

96. 96

97. 97

98. EKG Leads
98

99. Blood
Glucometer
See EMR transition media for glucometer and diabetic emergencies.
99

100. Glucose Insulin
Insulin on receptor Glucose enters cell
opens glucose channel
Insulin
Glucose
receptor
channel
Body Cell Nucleus
The Body’s Glucose Needs
100

101. Infant 40 – 90 mg/dL
Child < 2 years 60 – 100 mg/dL
Child > 2 years to Adult 70 – 105mg/dL
(Pagana & Pagana, 1997, 427)
Normal Blood-Glucose Levels
101

102. Newborn < 30 and > 300 mg/dL
Infant < 40 mg/dL
Adult Female < 40 and > 400 mg/dL
Adult Male < 30 and > 300 mg/dL
(Pagana & Pagana, 1997, 427)
Critical Values
102

103. Types of
Diabetes
103

104. Clinical
Presentation
104

105. Emergency Care of
Diabetes
105

106. How a Glucometer Works
106

107. 107

108. 108

109. Puncture Sites
109

110. 110

111. 111

112. 112

113. 113

114. 114

115. 115

116. Maintenance and Use
116

117. Trouble Shooting
117

118. Oral
Glucose
Administration
118

119. 119

120. Blood Glucometer
120

121. Catheters
121

122. Texas Catheter
122

123. Foley Catheter
123

124. Monitoring
124

125. Handling
125

126. Documentation
126

127. Complications
127

128. Urinary Catheter Monitoring
128

129. Photography and Image Credits
©Duodote
Slide 70
© Enject
Slide 68
© iStock Photography. Used with permission. No resale or reproduction of these images is permitted.
Slides: 29, 83,
© Jeremy Hoose and Destry Lynn (Labette Health EMS) Used with permission. No resale or reproduction of these images is
permitted.
Slides 19, 109,110, 111, 112, 113, 114, 115
© Jon E. Friesen, Used with permission. No resale or reproduction of these images is allowed without express permission of the
photographer.
Slides:
6,7,9, 11, 12, 15, 35, 36, 37, 38, 40, 41, 42, 45, 47, 50, 51, 61, 62, 64, 65, 66, 67, 69, 70, 71, 72, 77, 78, 79, 82, 84, 85, 88, 94, 9
5, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 107,
© Lippincott Williams & Wilkins. Used with permission. No resale or reproduction of these images is permitted.
Slide 83,
129