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Spring 2011

Skills Manual

Cabrillo College

EMT Training Program

FT-183L

Instructor: Shane Bell

Program Director: Kris Hurst

Table of Contents

i

Lab Schedule ....................................................................................................................... 1 Proctor Statements for Midterm Skills ............................................................................... 7 Proctor Statements for Final Skills ...................................................................................... 9 Patient Assessment Algorithm .......................................................................................... 11 Lab 1 Skills

Proper Removal of Contaminated Gloves ................................................................... 12 Body Substance Isolation ............................................................................................. 13 Initial Assessment ........................................................................................................ 14 Head-Tilt/Chin-Lift Maneuver ................................................................................... 15 Jaw Thrust Maneuver .................................................................................................. 16

Lab 2 Skills Chest Auscultation ....................................................................................................... 17 Vital Signs .................................................................................................................... 18 Pocket Mask Ventilation .............................................................................................. 20 Bag Valve Mask Ventilation ........................................................................................ 21 Bag Valve Mask Ventilation, Two-Person .................................................................. 22 Oropharyngeal Airway ................................................................................................. 23 Nasopharyngeal Airway ............................................................................................... 24 Suctioning the Oropharynx .......................................................................................... 25

Lab 3 Skills Oxygen Administration ................................................................................................ 26 Application of a Cervical Collar ................................................................................... 27 Detailed Physical Exam ............................................................................................... 28 Trauma Patient Assessment ........................................................................................ 30

Patient Interview/Assessment and General Event Flow .................................................. 31 Lab 4 Skills

Neurological Exam ....................................................................................................... 34 Bleeding Control and Shock Management .................................................................. 35 Combat Application Tourniquet (C-A-T) .................................................................... 36 Joint Immobilization..................................................................................................... 37 Long Bone Immobilization ........................................................................................... 38 Bandaging and Splinting an Open Extremity Fracture .............................................. 39 Sling and Swathe Immobilization ................................................................................ 40

Lab 5 Skills Kendrick Extrication Device (KED) ............................................................................ 41 Helmet Removal ........................................................................................................... 42 Lifting and Moving Patients ........................................................................................ 43 Spine Immobilization Supine Patient ........................................................................... 44 Spine Immobilization Standing Patient ....................................................................... 45 Application of Soft Restraints ...................................................................................... 46

Lab 6 - Midterm Skills Review Lab 7 - Midterm Skills Testing

Table of Contents

ii

Lab 8 Skills

Rapid Extrication ......................................................................................................... 47 Administration of Glucose ........................................................................................... 48 Administration of Nitroglycerin .................................................................................. 49 Epinephrine Auto-Injector ........................................................................................... 50 Administration of Nebulized Medication ..................................................................... 51 Administration of Activated Charcoal ......................................................................... 52 Metered Dose Inhaler................................................................................................... 53 Medical Patient Assessment......................................................................................... 54

Lab 9 Skills Adult and Child One-Rescuer CPR .............................................................................. 55 One-Rescuer CPR with AED ....................................................................................... 56 Infant One- and Two-Rescuer CPR ............................................................................. 58 Adult and Child Foreign Body Airway Obstruction: Unresponsive Patient .............. 59 Adult and Child Foreign Body Airway Obstruction: Responsive Patient .................. 60 Infant Foreign Body Airway Obstruction ................................................................... 61 Endotracheal Tube BVM Ventilation .......................................................................... 62 Artificial Ventilation of a Stoma Breather ................................................................... 63 Suctioning Through an Endotracheal Tube ................................................................ 64 Suctioning a Stoma ....................................................................................................... 65

Lab 10 Scenario Stations Medical Patient Assessment-Responsive: Chest Pain ................................................. 66

Lab 11 Skills Emergency Childbirth .................................................................................................. 68 Hare Traction Splint .................................................................................................... 70 Sager Traction Splint ................................................................................................... 71 Impaled Objects – Penetrating Eye Injury .................................................................. 72 Impaled Object Stabilization ........................................................................................ 73 Avulsion (Complete) or Amputation ............................................................................ 74 Sucking Chest Wound .................................................................................................. 75

Lab 12 - MCI Drill Lab 13 - Final Skills Review Lab 14 - Final Skills Testing Additional Skills

Pulse Oximetry ............................................................................................................. 76 Cooling Measures - Infant............................................................................................ 77 Insertion of Esophageal Combitube (ETC Airway)..................................................... 78 Insertion of Nasogastric Tube (NG Tube) .................................................................. 80

Basic Skills Evaluation Summary Check-Off ...................................................................... 81 Vital Signs Check-Off ......................................................................................................... 82 CPR Check-Off ................................................................................................................... 83 Spine Board Strapping Check-Off ...................................................................................... 84 Mnemonics ...............................................................................................Inside Back Cover

Lab Schedule – Spring 2011

1

Lab 1 – 2/11

Watch the following videos prior to lab: Introduction to patient assessment, initial assessment and scene size-up, BSI, head tilt, and jaw thrust.

Add slips given as needed, SRTs formed

Introductions of SRT members, last day for lab fee payment ($162, checks to Cabrillo Public Safety), glove sizing and distribution

Review Lab Policies from lab orientation Practice Proper Removal of Contaminated Gloves skill sheet (no video) Body Substance Isolation (BSI) skill sheet sign off

Weekly equipment check-off procedure Go over patient documentation: Patient Care Worksheet; Refusal of Service

(AMA) Head-Tilt/Chin-Lift Maneuver skill sheet sign off Jaw Thrust Maneuver skill sheet sign off

Initial Assessment skill sheet sign off, verbalize from memory through initial assessment with another SRT member. Turn in skill sheet to Lab Instructor

for their review. Lab 2 – 2/25

Watch the following videos prior to lab: Vital Signs-Pulse, Respirations, BP,

Skin Signs, Pupil Assessment (1-6), Pocket mask, 1 and 2-Person BVM, OPA, NPA, Oral suctioning, Adult Rescue Breathing with Bag Mask (see BLS for the HCP video)

Equipment check-off

Pocket mask distribution Review Patient Assessment Algorithm (lab manual)

Chest Auscultation skill sheet sign off Vital Signs skills sheet (sign off on all vital signs)

o Pulse, Respirations, BP Auscultated, BP Palpated, Skin, Pupils

Airway management skills (Skills sheets and videos.) o Pocket Mask Ventilation

o Bag Value Mask Ventilation o Bag Value Mask Ventilation, Two-Person o Oropharyngeal Airway

o Nasopharyngeal Airway o Suctioning the Oropharynx

Practice Initial Assessment Quiz #1: Verbalize Initial Assessment skill sheet from memory.

*** Next lab there will be an Initial Assessment skills test station. All students

must verbalize down the Initial Assessment skill sheet exactly as written on the skills sheet. If this skill is failed you must retest with Shane or Kris by appointment.

This skill must be passed in order to continue in the course.

A minimum of one hour per week outside of class is required of all students to view

the EMT skills videos online, and to study the lab manual skills sheets.

This work is expected to be completed prior to lab.


2

Lab 3 – 3/4

Watch the following videos prior to lab: oxygen tank assembly, nasal cannula, non-rebreather mask, pulse oxymetry, trauma patient assessment, significant MOI,

no significant MOI, detailed physical exam, ongoing assessment, cervical collars Equipment check-off Oxygen Administration skill sheet sign off

Detailed Physical Exam (DCAP-BTLS) skill sign off Application of a Cervical Collar skill sheet sign off. Practice sizing and placing

cervical collars Trauma Patient Assessment skill sign off Partner in your SRT and verbalize through SAMPLE History Questions

Vital Signs Check-Off (Back of lab manual, all 10 must be signed off by a TA before the lab final) Practice, Practice, Practice

*** SRTs will rotate through an Initial Assessment TEST station. All students must verbalize down the Initial Assessment skill sheet exactly as written

on the skills sheet to continue in the course. If this skill is failed you must retest with Shane or Kris by appointment.

Lab 4 – 3/11

Watch the following videos prior to lab: bleeding and shock, dressing and bandaging, long bone splinting, joint splinting, sling and swathe

Equipment check-off Review Neurological Exam skill sheet. Discuss its application in extremity

injuries.

Bleeding Control and Shock Management skill sheet sign off Combat Application Tourniquet (C-A-T) skill sheet sign off

Joint Immobilization skill sheet sign off. Read through and discuss specific management of elbow, shoulder, knee and ankle injuries (see Chapter 28 for various examples).

Long Bone Immobilization skill sheet sign off (cardboard & SAM splints) Bandaging and Splinting an Open Extremity Fracture skill sheet. Discuss

primary concerns and sign off skill sheet. Sling and Swath skill sheet sign off Demo the use of a pillow splint for an ankle injury

Vital Signs Check-Off Quiz #2: Detailed Physical Exam skill sheet individually quizzed (SRTs go

through station)


3

Lab 5 – 3/18

Watch the following videos prior to lab: KED, immobilizing supine pt, immobilizing standing pt, helmet removal, rapid extrication, lifting and moving pts,

soft restraints Equipment check-off Kendrick Extrication Device (KED) skill sheet sign off

Helmet Removal skill sheet sign off Backboard Use and strapping techniques

Spine Immobilization Supine Patient skill sheet sign off Discuss Application of Soft Restraints (pgs. 554-558), sign off skill sheet Spine Immobilization Standing Patient skill sheet sign off

Spine Board Strapping Check-Off (back of lab manual, all must be signed off by a TA before the skills lab final)

Review Neurological Exam skill from Lab 4 and talk about its application to head and spinal injuries.

Discuss Lifting and Moving Patients, sign off skill sheet

Practice the use of gurney, scoop, stair chair, readibed, sit pick, rescue seat Vital Signs Check-Off

Lab 6 – 3/25 Midterm Skills Review

Mid-term Skills:

o 1 Person BVM (Oropharyngeal Airway and Bag Valve Mask

Ventilation) o Oxygen Administration

o NPA and Suctioning (Nasopharyngeal Airway and Suctioning the Oropharynx)

o Vital Signs o Spine Immobilization Supine Patient

o Patient Assessment Detailed Physical Exam Vital Signs Check-Off

Spine Board Strapping Check-Off

Lab 7 – 4/1 Midterm Skills Testing (1030 – 1530 hours)

Mid-term Skills:

o 1 Person BVM (Oropharyngeal Airway and Bag Valve Mask Ventilation)

o Oxygen Administration o NPA and Suctioning (Nasopharyngeal Airway and Suctioning the

Oropharynx) o Vital Signs

o Spine Immobilization Supine Patient

o Patient Assessment Detailed Physical Exam


4

Spring Break–4/8 No Lab

Lab 8–4/15 Rapid Extrication(Part 1) and Medical Scenarios (Part 2)

Watch the following videos prior to lab: (Part 1) rapid extrication, immobilize

supine pt, immobilize standing pt, trauma patient significant MOI, (Part 2) activated charcoal, glucose paste, metered dose inhaler, nitroglycerin, epi auto inject, nebulized medication, responsive medical pt, unresponsive medical pt

Equipment check-off Spine Immobilization Standing Patient (review)

Rapid Extrication skill sheet and scenarios Administration of Glucose skill sheet check off Administration of Nitroglycerin skill sheet check off

Epinephrine Auto-Injector skill sheet check off Administration of Nebulized Medication skill sheet check off

Administration of Activated Charcoal skill sheet check off Metered Dose Inhaler skill sheet check off Medical Patient Assessment skill sheet (discuss the differences in assessment

between the responsive and unresponsive medical patient), then check off Medical Scenarios

Vital Signs Check-Off Spine Board Strapping Check-Off

Lab 9 – 4/22

Watch the following videos prior to lab: adult 1-rescuer CPR, adult breaths with mask, adult rescue breathing with bag mask, adult 2-rescuer CPR demo, adult 2-rescuer CPR and AED, adult 2-rescuer advanced airway, child CPR sequence,

infant 1-rescuer CPR, infant compressions, infant 2-rescuer CPR demo, ET intubation, Suctioning through an ET tube, Combitube

Adult and Child One-Rescuer CPR skill sheet check off One-Rescuer CPR with AED skill sheet check off (Discuss cautions with the

AED pgs. 419-421)

Infant One- and Two-Rescuer CPR skill sheet check off Adult and Child FBAO: Unresponsive skill sheet check off

Adult and Child FBAO: Responsive skill sheet check off Infant FBAO skill sheet check off Endotracheal Tube BVM Ventilation skill sheet check off

Discuss Artificial Ventilation of a Stoma Breather (p.154, 869),check off skill sheet

Discuss French catheter use in Suctioning Through an ET Tube (pg.1058) Discuss Suctioning a Stoma, check off skill sheet Cardiac Arrest Scenarios


CPR Check-Off (Back of lab manual, all must be demonstrated and signed before final skills test)


5

Lab 10 – 4/29 – Scenario Stations

Equipment Check Off Medical Pt Assessment-Responsive: Chest Pain skill sheet check off

Today is all scenario day. These are meant to be real time, not simply verbalization situations. Assess, do vitals, get SAMPLE history, and do all appropriate treatment on your patients. Practice handover verbal reports to

the hospital. Major Trauma (unconscious)

Cardiac Arrest Scenario Minor Trauma Scenario Medical Scenario


CPR Check-Off

Lab 11 – 5/6

Watch the following videos prior to lab: hare traction splint, sager traction

splint, assisting with childbirth Equipment check-off Emergency Childbirth skill sheet check off

Hare Traction Splint skill sheet check off Sager Traction Splint skill sheet check off

Discuss treatment management for an avulsion or amputation (p.658), then check off Avulsion (Complete) or Amputation skill sheet

Discuss Impaled Objects-Penetrating Eye Injury (p.657), then check off skill

sheet Discuss Impaled Object Stabilization (p.655), then check off skill sheet

Simulate a sucking chest wound & demonstrate treatment management using an occlusive dressing and discuss “cautions” (pgs.663-665), then check off Sucking Chest Wound skill sheet


CPR Check-Off Lab 12 – 5/13 MCI Drill

Equipment check-off

MCI and triage drill


6

Lab 13 – 5/20 Final Skills Review

Equipment check-off Final Skills Practice - Open Lab

o Medical Patient Assessment – Responsive: Chest Pain o One-Rescuer CPR with AED o Emergency Childbirth

o Infant One- and Two-Rescuer CPR o Hare Traction Splint

o Bleeding Control and Shock Management o Sling and Swathe Immobilization

Vital Signs Check-Off

Spine Board Strapping Check-Off CPR Check-Off

Lab 14 – 5/27 Final Skills Testing (1030 – 1530 hours)

Final Skills o Medical Patient Assessment – Responsive: Chest Pain

o One-Rescuer CPR with AED o Emergency Childbirth o Infant One- and Two-Rescuer CPR

o Hare Traction Splint o Bleeding Control and Shock Management

o Sling and Swathe Immobilization

At 1530 Course Completion Certificates will be awarded to individuals who

have completed all portions of the course and passed the written final exam with 70% or better. There will be a short reception with refreshments

immediately following.

7

Proctor Statements for Midterm Skills

Initial Assessment: An initial assessment is an EMT’s “bread and butter”. From memory verbalize down

the initial assessment exactly as it is written on the skills sheet concept for concept. If you leave out any

concepts this constitutes a failure. Demonstrate how to open an airway with a head-tilt, chin lift

method and with a jaw thrust method if you suspect spinal injuries.

Patient Assessment Detailed Physical Exam: A detailed physical assessment begins with scene size-up

and initial assessment. Assume you have already completed these two steps. The assessment you

complete for a minor versus major trauma is different. What is the difference? Student states, “I

would do a focused history and physical exam on a minor trauma patient and a rapid trauma

assessment on a major trauma patient”. Explain the pre-assessment steps in the detailed physical

exam. Student verbalizes down the 3 bullet points under pre-assessment. State what the acronym

DCAP-BTLS stands for. Student states, “Deformity, contusions, abrasions, punctures (or penetrations),

burns, tenderness, lacerations and swelling”. Continue to perform all assessment steps you would do

to look for unknown injuries on a trauma patient. Student works down the head to toe and verbalizes

all bullet points on the skill sheet. Two bullet points missed throughout the entire exam is permissible

but more than two constitutes a failure for this skill. Anything left out in the bullet point is a missed

bullet point. At the end of the exam ask, “Is there anything else you would like to add?”

1 Person BVM: You have been asked to ventilate a non-breathing patient. How do you assess for a

patient’s need to be ventilated? (Student states, “ I would look, listen and feel with my ear over the

patient’s mouth, watching for chest rise for 5-10 seconds.”) Measure and insert an OPA and then

demonstrate ventilating an adult patient with a bag valve mask. (Proctor asks, “What is the flow rate

for a BVM?”) Student states, “15 LPM”. (Proctor asks, “How often do you ventilate an adult? A

child?” Student states, “1 breath every five to six seconds (10-12 breaths per minute) for adults and

one breath every three to five seconds (12-20 breaths per minute) for children.”

Oxygen Administration: In this station you demonstrate how to administer oxygen. How do you assess

a patient’s need for oxygen? (Student states, “I am assessing the patient’s need for oxygen by

observing patient’s skin signs, pulse oximetry level and breathing effort.”) Assemble the oxygen

administration system, and demonstrate how to administer oxygen to a patient with a nasal cannula and

a non-rebreather mask. (Proctor asks, “What is the flow rate for a nasal cannula? What is the flow rate

for a non-rebreather mask? What instructions would you give the patient while the cannula or non-

rebreather mask is in place?”) Student states, “1-6 LPM for a nasal cannula or 12-15 LPM for a non-

rebreather mask. I would instruct the patient to breathe normally while the cannula or non-

rebreather mask is in place.”

8

NPA and Suctioning: Demonstrate measuring and inserting an NPA. Proctor asks, “If the NPA has a

bevel, how is the NPA oriented to the patient?” Student states, “Insert NPA with bevel pointing

toward septum.” Proctor asks, “How do you know if the NPA is fully inserted?” Student states, “The

flange or proximal ring should rest against the end of the nostril.” Assemble and demonstrate how to

suction a patient with a rigid suction tip. Proctor asks, “How do you position the patient’s head when

suctioning a patient?” Student states, “Tilt the patient’s head back in the sniffing position.” Proctor

asks, “When do you actually suction the patient? How long should you suction a patient?” Student

states, “Suction as catheter is withdrawn. Limit suction to 15 seconds.”

Vital Signs: Using another student demonstrate how to take a respiration rate, pulse rate and

auscultated blood pressure. As you take the respiratory and pulse rate explain what you are counting

and multiplying by. What things do you report regarding the respiratory rate and pulse rate? Student

states, “I will count the number of breaths in 30 seconds and multiply by 2 or in 15 seconds and

multiply by 4. I will report the respiratory rate, rhythm and quality of breathing. I will count the

number of beats in 15 seconds and multiply by 4. If the pulse is slow or irregular I will count the beats

in 30 seconds and multiply by 2. I will report the pulse rate, strength and regularity.” Verbalize how

to take a palpated blood pressure. Student does not have to actually demonstrate palpated BP, only

explain how to do it. Student should verbalize down the bullet points on the skills sheet. Student may

miss 1 bullet point and still pass the skill of auscultated BP. More than 1 bullet point in this area

constitutes a failure. Proctor asks, “What other things do you assess for during vital sign checks? What

does PERL stand for?” Student states, “Skin color, temperature and moisture condition. Also pupils

are assessed. PERL stands for pupils are equal and reactive to light.”

Spine Immobilization Supine Patient: With the assistance of 2 other students completely immobilize a

supine patient beginning with directing manual in-line position. Your job is to direct all members of the

crew, correctly place the board, evaluate the patient’s positioning on the board and secure the patient

to the long board using straps and a head bed. As you complete securing the patient to the board,

demonstrate where you would place tape on the patient but do not place the tape on the patient.

Direct the person at the head to make the call for the log roll. Normally crews work as teams. For this

testing purpose however, other than the log roll itself, no member of the team is to give any assistance.

After the log roll only the assistant at the head is to participate in the rest of the skill. Use combat

strapping or spider strapping techniques only. (Note failure points: Failure to assess 2 PMS checks,

improperly fitting the c-collar, letting assistant let go of manual immobilization, not moving patient as a

unit, mal-positioning of patient on the board, improper order of securing patient to board are all failure

points.)

9

Proctor Statements for Final Skills

Hare Traction: With the help of 1 assistant and using another student as the patient, properly place a

traction splint. You arrive on scene of a patient who is complaining of leg pain. The patient states the

pain is 9 out of 10. The pain is accompanied by swelling and bruising to the middle section of the femur.

What are the indications to use a traction splint? “Student states, “a closed mid-shaft femur fracture

with no injuries to the proximal hip or distal leg, including the knee.” Proctor states, “There does not

appear to be any hip, knee or lower leg involvement. You suspect that the patient has an isolated closed

mid-shaft femur fracture. Place the hare traction splint on the patient to immobilize the possible

fractured femur. Direct your assistant as needed. He/she is not to assist except as directed by you.

(Note to student: the following are failure points-not knowing indications for traction splint, not

understanding the mechanics of ow the spoint works, not admusting splint to proper length, releasing

traction once it is pulled and not completing 2 PMS checks.)

Emergency Childbirth: You arrive on scene of a patient who states she thinks she is about to give birth

to a baby. After introducing yourself what assessment question should you ask to ascertain whether

you should check to see if the baby is coming? (Answer: Do you feel the need to bare down or move

your bowels?”) What 4 key questions would you like to ask if time permits? (Note to student: not

knowing these is a failure point to the skill) After the questions, proceed with the necessary steps to

deliver this woman’s baby. (Key point: The following are failure points to this skill: (1) After the head of

the baby delivers be sure that the student checks for the presence or absence of the umbilical cord

around the baby’s neck. (2) Not suctioning the baby’s mouth once head is delivered. (3) Not

suctioning the baby a second time. (4) Not stimulating, drying or warming by wrapping in a blanket. (5)

Not knowing correct clamp placement.) Note to proctor: do not have student actually close the clamps

on the cord but only demonstrate and verbalize the landmarks to place them. Proctor asks, “What is

APGAR and when do you check for it?” Student states, “Appearance, Pulse, Grimace, Activity and

Respiratory effort. You assess for these things in the baby at 1 and 5 minutes.” Proctor asks, “What

do you do if you can not control the mother’s vaginal bleeding?” Student states, “Massage the fundus

lightly with a circular motion.”

One-Rescuer CPR with AED: “You are in a gym where a man goes suddenly unconscious while

playing basketball. Assume the Emergency Response System has been activated. You are working

at the gym and arrive within two minutes with an AED. You also have a pocket mask or BVM

available. Demonstrate what you would do to treat this individual. (Student should work through

the skill sheet.) “When you recheck for a pulse, you find one, but the patient is not breathing.

Demonstrate what you need to do now”. (Student should demonstrate rescue breathing, 1

breath every 5-6 seconds.) “Continue to demonstrate rescue breathing for 1 full minute”.

(Student will give 10-12 breaths in the minute time with the majority of them resulting in

visible chest rise.) “The patient is now breathing on his own. What further treatment could you

do?” (Student should state, “Place the patient in recovery position and put them on a non-

rebreather mask at 15 liters per minute”.)

10

Bleeding Control and Shock Management: You have a patient who has a deep gash to their

forearm that appears to be spurting bright red blood. Demonstrate how to control the bleeding.

Student should hold pressure, elevate and demonstrate correct pressure point at the

brachial artery. Student should then apply a pressure bandage using a 4X4 and cling or a

triangular bandage. Proctor states, “If your patient is showing signs of shock what should you

do?” Student should verbalize down the rest of the skill sheet. If student has not already

stated, proctor asks, “What 3 things should you reassess during bleeding control and shock

management?” Student should state, “Check for presence of radial pulse, observe skin signs

and check for capillary refill time.”

Infant CPR 1 and 2 Person: “You are at a party with some friends off duty when a parent runs up

to you with his infant and says, “My baby is not breathing! Help her!” The baby is limp and turning

blue. Place the baby on a firm surface. Proceed with your assessment.” (Student should work

through the Infant One- and Two-Rescuer CPR skills sheet beginning with assessing for

responsiveness and activating EMS. Student will demonstrate 5 cycles of 30:2 compressions

and ventilations beginning with opening the airway and checking for breathing.) The proctor

now states, “After the 5th cycle of compressions and ventilations you recheck for a pulse and still do

not find one. I will act as a second rescuer and take over at airway.” (Student should

demonstrate the 2 thumb-encircling hands technique of chest compressions and change to a

15:2 compression to ventilation ration for 2 person infant CPR.) “Do 2 cycles of CPR”. The

proctor then states, “After 2 minutes you assess the infant and there is a pulse, but the baby is not

breathing. Demonstrate what you need to do.” (Student should demonstrate rescue breathing,

one breath every 3-5 seconds with the majority of ventilations resulting in visible chest rise.)

Patient Assessment Medical: Proctor states, “Your patient complains of cardiac-like chest pain.

Assume the scene size-up and initial assessment have been completed. What questions will you ask

your patient as part of your chest pain assessment?” (Student should answer according to

OPQRST.) Proctor asks, “What does SAMPLE stand for?” (Student answers per skill sheet.)

Proctor asks, “What do you assess during your focused physical exam?” (Student works through

the physical exam and focused history questions on the skills sheet.) Proctor asks, “What else

do you do for a patient with suspected cardiac chest pain?” (Student states, “Obtain baseline

vital signs, assist patient to take their own nitroglycerin if BP is above 100 systolic and they

are not on ED medication, make transport decisions and consider doing a complete detailed

physical exam.”) Proctor states, “This completes the medical assessment.”

Sling and Swathe: You respond to a patient who has what appears to be a dislocated shoulder.

The patient is self-splinting the injury. There is no second rescuer. Demonstrate how to immobilize

this injury using a sling and swathe. (Failure points are not assessing for PMS in the injured

extremity 3 times or not knowing how to apply the sling and swathe.)

11

Patient Assessment Algorithm

Cabrillo College EMT Training Program Body Substance Isolation (BSI)

Student’s Name___________________________________Pass____Fail____ Examiner’s Name_________________________________Date____________

13

Procedure Yes No Comments

Preparation

Explain to patient the reasons for applying BSI.

Apply gloves.

Apply eye protection.

Apply mask, if appropriate.

Apply gown, if appropriate.

Patient Interaction

Provide appropriate assessment and treatment.

Consider changing gloves if they are to be worn for an extended period of time.

Change gloves

immediately if they

become damaged.

Cleanup

Gather any contaminated materials from the scene, and place in an appropriate disposal bag

or container.

Remove personal protection when there is no further risk of exposure.

Be careful not to contaminate yourself during removal of personal protection equipment.

Dispose all contaminated materials and gloves, masks and gowns in proper infection control

waste disposal container.

Wash hands as soon as possible with an approved infection control soap or other solution.

Document the incident.

If at any time you feel you

may have been exposed to

blood or body fluids, fill out

appropriate forms provided

to you by your agency, and

contact your infection

control coordinator. If you

have been directly exposed,

seek medical attention

immediately. Consult your

agency’s policies and

procedures.

Cabrillo College EMT Training Program Initial Assessment

Takes or verbalizes body substance isolation precautions


14


Scene Safety and Size-up (5 questions)

Is the scene safe? Trauma patient (Mechanism of Injury (MOI)) or medical patient (Nature of

Illness (NOI))? What is the number of patients? What additional resources do I need? Do I

need to take C-spine precautions?

Initial Assessment Overview

Verbalize general impression of patient. (big sick or little sick)

Determine level of consciousness. Is the patient alert, or responsive to verbal or painful stimuli,

or unresponsive? (AVPU) If the patient is alert, are they oriented to person, place, time and

event? (A&OX4)

Determine chief complaint.

Airway

Is the airway open? If not open it with the head-tilt/chin-lift method or modified jaw thrust if

C-spine precautions are needed. (Demonstrate these two methods of opening the airway.)

Use suction as needed.

Insert OPA or NPA adjuncts if appropriate.

Breathing

Assess for the presence, rate, rhythm and quality of breathing.

Apply oxygen if needed here. Begin rescue breathing if patient is apneic.

Circulation

Assess for the presence, rate, regularity and strength of the pulse. If no pulse begin CPR and

attach an AED.

Assess skin color, temperature and moisture condition.

Check for and control any major bleeding.

Initiate shock treatment if signs of shock are apparent.

Decide Patient priority for immediate transport

Objective: The examinee will perform an initial assessment and verbalize through entire skill verbatim.

Equipment: Manikin or simulated patient.

Cabrillo College EMT Training Program Head-Tilt/Chin-Lift Maneuver



15


Positioning

Place the patient in the supine position.

Place yourself to the side of the patient if possible.

Maneuver

Place the palm of one hand on the patient’s forehead.

Place the fingers of your other hand under the bony part of the lower jaw near the chin.

While applying pressure down on the forehead, simultaneously using the fingers of the other hand lift the jaw upward, bringing the chin forward. Do this until the teeth of the lower mouth almost touch the teeth of the upper.

Try not to close the patient’s mouth during maneuver.

Assess for breathing and ventilate as needed.

Objective: The examinee will demonstrate the proper method for the head-tilt/chin-lift maneuver.

Equipment: Manikin.

Cabrillo College EMT Training Program Jaw Thrust Maneuver



16


Positioning

Place the patient in the supine position.

Place yourself at the top of the patient’s head if possible.

If the patient is not supine, carefully keep the patient in a neutrally aligned position and roll them as a unit into the supine position.

Maneuver

Without moving the head and neck, carefully place one hand on either side of the patient’s head near the orbits.

Place your thumbs just inferior to the eyes and lateral to the nose.

Place your fingers at the angle of the jaw below the ears.

Without moving the head and neck, using your index and middle fingers, pull the angle of the jaw forward (jut the jaw).

Try not to close the patient’s mouth during maneuver.

Assess for breathing and ventilate as needed.

Objective: The examinee will demonstrate the proper method for the jaw thrust maneuver.

Equipment: Manikin.

Cabrillo College EMT Training Program Chest Auscultation



17


Direct patient to breathe deeply through an open mouth.

Place stethoscope diaphragm directly on patient’s skin.

Listen

In a minimum of 4 fields anterior (front) and posterior (back):

Anterior

3 fingers breadth below the clavicle at the midclavicular line, on right and left sides.

Just below the nipple line (6th

intercostals space) midaxillary, on right and left sides.

Posterior

Upper back, 3 fingers breadth below the shoulder (not over the scapular bone), on right

and left sides.

3 fingers breadth below the scapular bone, on right and left sides.

Objective: The examinee will demonstrate proficiency in auscultating breath sounds.

Equipment: Stethoscope, simulated patient.

Cabrillo College EMT Training Program Vital Signs


18


Pulse

Palpate the radial pulse with two fingers if the patient is conscious. Palpate the carotid pulse if

the patient is unconscious. For infants palpate the brachial pulse.

Count the number of beats in 15 seconds and multiply by 4. If pulse is slow or irregular count

the beats in 30 seconds and multiply by 2.

Report the rate, regularity and strength of the pulse.

Respirations

Check for the presence or absence of breathing by watching for the rise and fall of the chest.

Observe the patient’s position (tripod position indicates respiratory difficulty).

Count the number of breaths in 30 seconds and multiply by 2 or in 15 seconds and multiply by

4 to determine the number of breaths per minute.

Report the rate, rhythm, and quality of breathing.

Blood Pressure Auscultated

Apply blood pressure cuff 1” above the antecubital area. Palpate the brachial artery and place

the center of the bladder just above it.

Don’t place it over clothing.

Fit it snuggly.

Place the diaphragm of the stethoscope over the brachial artery.

Inflate the blood pressure cuff rapidly.

Deflate the cuff slowly and note when the heart beat is first heard and when it is no longer

heard. These two numbers are the systolic and diastolic numbers of the blood pressure.

Report the auscultated systolic and diastolic blood pressure.

Cuff should cover 2/3 of

upper arm.

Procedure continues on the next page.

Cabrillo College EMT Training Program Vital Signs

Procedure continued from previous page


19


Blood Pressure Palpated

With blood pressure cuff still in place, feel for the radial pulse.

Inflate the cuff to at least 10mm Hg over the point where the radial pulse ceases to be palpable.

Deflate cuff slowly.

Note when the radial pulse returns. This is the systolic blood pressure.

Report the systolic blood pressure over “P” for “palpated”.

Skin

Check for overall color of the skin, mucous membranes and nailbeds.

Determine skin temperature by feeling the forehead with the back of the hand.

Determine skin moisture.

Pupils

Note the size of the pupil before shining any light into the eyes.

Cover one eye while shining light into the other eye. Move the light from lateral (outside the

eye) to medial.

Note the reactivity and change in size of the pupil.

Repeat the exam on the other eye.

Document PERL (Pupils are Equal and Reactive to Light) or pertinent negatives if pupils do

not respond normally.

Objective: The examinee will demonstrate how to take vital signs on a patient.

Equipment: Blood pressure cuff (sphygmomanometer), stethoscope, penlight, patient.

Cabrillo College EMT Training Program Pocket Mask Ventilation



20

Objective: The examinee will demonstrate proficiency ventilating an apneic patient using a pocket mask.

Equipment: Adult airway manikin, pocket mask. Special Instructions: To clean remove filter. Wash and scrub with soapy water. Rinse in clean water. Submerge for 10 minutes in 1:64 household bleach/water solution. Rinse. Air dry.


Assess

Assess patient’s breathing. Look, listen and feel (with your ear over the patient’s mouth watch

for chest rise for 5-10 seconds).

Assemble

Push out dome of face piece. Attach one-way valve to mask, exhalation valve away from

“nose” end of mask.

Position mask over patient’s nose & mouth. Position yourself at head of patient.

Airway

Open the airway by using the head tilt/chin lift or modified jaw thrust if C-spine precautions are

needed.

Insert an OPA or NPA as appropriate.

Connect oxygen tubing to pocket mask if there is an oxygen inlet. Some types of pocket masks

do not have an O2 inlet.

Center the pocket mask on the patient’s face so that the triangle is over the bridge of the

patient’s nose and the wider part is placed between the lower lip and the chin.

Breathing

Seal mask by circling thumb & 1st finger around top of mask and opening airway by 3

rd, 4

th &

5th

fingers lifting the jaw. Pull the jaw up towards the mask.

Blow slowly into valve over 1-2 seconds. Observe for chest rise.

Remove mouth and allow patient to exhale.

Ventilations should be 1

breath every 5 seconds

for an adult. Children

and infants should be

ventilated at a rate of 1

breath every 3-5 seconds

depending on their size.

Circulation

If the patient does not have a pulse, perform CPR as usual. If alone consider using the attached

head strap if there is one. This will help to maintain alignment of the mask on the patient.

Reassess Airway/Ventilations

Cabrillo College EMT Training Program Bag Valve Mask Ventilation



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Assess

Assess patient’s breathing. Look, listen and feel (with your ear over the patient’s mouth watch for

chest rise for 5-10 seconds).

Assemble Equipment

Open oxygen source and ensure pressure is adequate.

Connect one end of oxygen tubing to flow meter of O2 cylinder and the other to the BVM.

Set flow meter to 15 LPM.

Attach mask to BVM.

Ensure the equipment is

operational.

Airway

Open airway by tilting patient’s head back in the sniffing position.

Suction airway, if required.

Measure and insert an OPA.

Do not ventilate a patient

with fluid in their

pharynx.

Ventilation

Position yourself at head of patient.

Position the mask on the patient and using the “E-C” technique, seal the mask and maintain an

open airway.

With your other hand, squeeze the bag slowly (1 second) while watching for chest rise.

Give one breath every five to six seconds (10 to 12 breaths per minute) for adults.

Give one breath every three to five seconds (12 to 20 breaths per minute) for children and

infants.

Watch for chest rise on each ventilation.

If the patient has a

mustache or beard, there

are no differences in this

procedure.

Reassess Airway /Ventilations

Objective: The examinee will demonstrate proficiency ventilating an apneic patient using a Bag Valve Mask attached to a supplemental

O2 source.

Equipment: Adult airway manikin, BVM, OPA, O2 tank with regulator/flow meter, oxygen tubing.

Cabrillo College EMT Training Program Bag Valve Mask Ventilation, Two-Person



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Assess

Assess patient’s breathing. Look, listen and feel (with your ear over the patient’s mouth watch

for chest rise for 5-10 seconds).

Assemble Equipment

Open oxygen source and ensure pressure is adequate.

Connect one end of oxygen tubing to flow meter of O2 cylinder and the other to the BVM.

Set flow meter to 15 LPM.

Attach mask to BVM.

Ensure the equipment is

operational.

Airway


Suction airway, if required.

Measure and insert an OPA.

Do not ventilate a patient

with fluid in their

pharynx.

Ventilation

First EMT:

Position yourself at head of patient.

Position the mask on the patient and using the “E-C” technique with each hand, seal the

mask and maintain an open airway.

Second EMT:

Squeeze the bag slowly (1 second).

Give one breath every five to six seconds (10 to 12 breaths per minute) for adults.

Give one breath every three to five seconds (12 to 20 breaths per minute) for children

and infants.

Both EMTs:

Watch for chest rise on each ventilation.

If the patient has a

mustache or beard, there

are no differences in this

procedure.

Reassess Airway /Ventilations

Objective: The examinee will demonstrate proficiency ventilating an apneic patient using a Bag Valve Mask attached to a supplemental

O2 source, along with a second rescuer.

Equipment: Adult airway manikin, BVM, OPA, O2 tank with regulator/flow meter, oxygen tubing, second rescuer.

Cabrillo College EMT Training Program Oropharyngeal Airway



23


Position Patient

Place the patient in supine position.

Measure Airway

Size airway from earlobe to corner of patient’s mouth or angle of jaw to midline of the lip.

Select proper size of oral airway.

Insert

Open patient’s mouth using the cross-finger technique.

Insert the airway with tip pointing toward roof of mouth until it reaches the base of the tongue.

Gently rotate airway 180 degrees.

Flange should rest against the outside of the lips.

If the patient begins to

gag at any stage of this

procedure immediately

remove the airway.

Remember to gently

insert the airway.


Objective: The examinee will demonstrate proficiency in sizing and placing an oropharyngeal airway.

Equipment: Adult airway manikin, a variety of OPA sizes.

Indications: Unconscious patient with no gag reflex.

Cabrillo College EMT Training Program Nasopharyngeal Airway



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Measure Airway

Visually select airway diameter slightly smaller than the patient’s nostril or compare NPA

external diameter with the diameter of patient’s smallest finger.

Size airway by measuring from patient’s side of nostril to the earlobe.

Lubricate with water soluble lubricant.

Insert

Gently push the tip of the nose upward.

Insert NPA with bevel pointing toward septum, gently rotating the airway side to side while

advancing it.

At no time should the airway be forced into the nostril.

If patient begins to gag immediately remove the airway and prepare to suction as needed.

Flange or proximal ring should rest against the end of the nostril when NPA is placed properly.


Objective: The examinee will demonstrate how to size and place a nasopharyngeal airway.

Equipment: Adult airway manikin, a variety of nasopharyngeal airways, lubricant.

Indications: Semiconscious or unconscious patient with a gag reflex unable to tolerate an OPA.

Cabrillo College EMT Training Program Suctioning the Oropharynx



25


Assess


Assess if patient’s airway is in need of suctioning.

Assemble

Assemble suction equipment by connecting rigid tip to tubing, then to suction source.

Ensure suction unit is working by turning it on, then off.

Airway

Measure depth of rigid suction tip insertion by measuring the distance from tip of earlobe to

side of nose following the curvature of the jaw.

Turn suction unit on.

Place patient on his or her side, or turn head to the side if possible.

Grasp lower jaw of patient and open the mouth wide.

Insert suction catheter to the measured depth.

Suction as catheter is withdrawn by placing your finger over the hole in the catheter tip.

Limit suctioning to 15 seconds.

Irrigate suction tip with solution as needed.

Repeat the above technique as needed.

Same measurement

length as an NPA.

Use pediatric setting for

children and infants.

Limit child and infant

suctioning to 5 seconds

using flexible suction tube

only.

Breathing

Ventilate apneic patient after suctioning or administer O2 as needed to a breathing patient.


Objective: The examinee will demonstrate proficiency in suctioning the oropharynx using a rigid suction tip.

Equipment: Adult airway manikin, rigid suction tip, connective tubing, suction unit, irrigating solution and container.

Cabrillo College EMT Training Program Oxygen Administration



26


Assess

Assess patient’s need for oxygen by observing patient’s skin signs, pulse oximetry level and

breathing effort.

Assemble

Connect yoke of the flowmeter-regulator to O2 tank by aligning pins into appropriate spaces on

the tank valve. Check for “O-ring” gasket. Hand-tighten the “T” screw on the oxygen

regulator.

Slowly open tank valve (use key if required) one-half turn to charge the regulator.

Check pressure gauge in O2 tank to see that adequate O2 is present. Verbalize pressure in PSI.

Nasal Cannula

Select nasal cannula and connect tubing to nipple of oxygen regulator.

Set flow rate at 1-6 LPM.

Place nasal cannula in manikin’s nose with nasal prongs curving downward.

Secure cannula by positioning tubing over the manikin’s ears. Bring remainder of tubing under

the manikin’s chin. Slide slip loop in place.

Instruct the patient to

breathe normally while

the cannula is in place.

Non-rebreather Mask

Select non-rebreather mask and connect tubing to nipple of oxygen regulator.

Set flow rate at 12-15 LPM.

Fill mask reservoir by placing finger over port at top of bag.

Place mask over manikin’s nose and mouth with apex of mask over the bridge of nose.

Secure mask on manikin by positioning the elastic strap so that it rests above the manikin’s ear

and tighten strap as needed.

Instruct the patient to

breathe normally while

the mask is in place.


Objective: The examinee will demonstrate how to connect a flowmeter-regulator to an O2 cylinder, turn it on and administer O2 via a

nasal cannula and non-rebreather mask.

Equipment: Adult airway manikin, O2 tank, flowmeter-regulator, cylinder key, nasal cannula, non-rebreather mask.

Cabrillo College EMT Training Program Application of a Cervical Collar



27


Approach

Approach the patient from the front, instructing them not to move.

Explain the procedure to the patient and gain consent to treat.

Stabilization

Maintain manual cervical stabilization. Have a second rescuer do this if possible.

Assessment

Inspect and palpate the neck and cervical spine.

Check for jugular vein distension (JVD), tracheal deviation and medic alert tag.

Inspect for stoma.

Evaluate pulse, motor function and sensation (PMS) in all extremities.

Measure the collar for a proper fit according to manufacturer’s instructions.

Application

Angle the collar for proper placement.

If patient is supine, slide the collar between the neck and the ground first, and then

wrap it around the front.

If patient is sitting or standing, slide the chin portion of the collar up the chest to the

chin, then wrap the collar around the back of the neck.

Fasten the collar in place.

Check for proper fit.

The collar should not

hyperextend the neck or

fit so snugly that it

constricts the airway.

Reassess

Reassess pulse, motor function and sensation (PMS) in all extremities.

Maintain manual

stabilization until patient

is fully immobilized.

Objective: The examinee will demonstrate the proper application of a cervical collar.

Equipment: Assorted sizes of cervical collar, patient, second rescuer.

Cabrillo College EMT Training Program Detailed Physical Exam


28


Perform scene size-up and initial assessment.

Student verbalizes, “I would do a focused history and physical exam on a minor trauma

patient and a rapid trauma assessment on a major trauma patient”.

Pre-assessment

Expose patient or injuries for assessment.

Direct crew to prepare backboard for patient transport (if needed).

Obtain SAMPLE history and vital signs as appropriate

Detailed Physical Examination (DCAP-BTLS)-Student states “I will be using the acronym DCAP-BTLS during my exam and it stands for: Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Tenderness, Lacerations and Swelling.

Assess the Head

Inspect and palpate the scalp and cranium for DCAP-BTLS plus crepitation and bleeding.

Inspect the eyes for pupil size and reactivity, bleeding in the anterior eye chamber and signs of

raccoon eyes.

Inspect the ears and nose for bleeding or clear fluid drainage (CSF).

Inspect the back of the ears for bruising (Battle’s sign).

Inspect the mouth for loose or broken teeth, lacerations on the tongue, unusual odors and listen

for a noisy airway (snoring, strider and secretions sounds).

Assess the neck

Inspect for DCAP-BTLS and palpate neck and cervical spine.

Check for jugular vein distension (JVD), tracheal deviation and medic alert tag.

Inspect for stoma.

Student verbalizes, “I would apply a cervical collar at this point of the physical exam if

appropriate”.

Procedure continues on next page.

Cabrillo College EMT Training Program Detailed Physical Exam



29


Assess the Chest

Inspect the chest for DCAP-BTLS plus crepitation, scars, and paradoxical motion.

Palpate the clavicles.

Palpate the chest (barrel hoop and sternum press with edge of hand).

Auscultate for presence and equality of breath sounds.

Assess the Abdomen

Inspect the abdomen for DCAP-BTLS.

Palpate the 4 quadrants of the abdomen for distension, rigidity, guarding and pulsating masses.

Assess the Pelvis

Inspect the pelvis for DCAP-BTLS plus priapism, incontinence and bleeding.

Check for outward rotation and shortening of each leg (sign of possible hip fracture).

Palpate the pelvis by gently pressing on the front and sides (barrel hoop) checking for stability.

Do not rock the pelvis

hard.

Assess the lower extremities

Inspect for DCAP-BTLS and palpate the lower extremities.

Assess for pulse, motor function and sensation (PMS) of the lower extremities. Assess the upper extremities

Inspect for DCAP-BTLS and palpate the upper extremities. Check for medic alert tag.

Assess for pulse, motor function and sensation (PMS) of the upper extremities.

Assess the back and buttocks

Roll patient onto side.

Inspect the posterior torso and buttocks for DCAP-BTLS and palpate the spine.

Often done when log

rolling the patient to a

spine board.

Treat any injuries discovered on the detailed physical exam as appropriate.

Objective: The examinee will demonstrate proficiency in performing a detailed physical exam.

Equipment: Patient or manikin, penlight, stethoscope, mat, shears for exposing injuries.

Cabrillo College EMT Training Program Trauma Patient Assessment



30



Is the scene safe? What is the Mechanism of Injury (MOI)? What is the number of patients?

What additional resources do I need? Do I need to take C-spine precautions?

Initial Assessment


Determine level of consciousness. (AVPU & A&OX4)


ABCs

Manage problems associated with the airway, breathing and circulation.

Administer high concentration of oxygen, if necessary.

Decide Patient priority for immediate transport.

Significant Mechanism of Injury

If the mechanism of injury was significant, perform a Rapid Trauma Assessment,

addressing life threats as they are discovered.

No-Significant Mechanism of Injury

If there is no significant mechanism of injury, perform a Focused History and Physical

Exam of the affected body system or area.

This includes inspection

and palpation of the

isolated area of

complaint.

Continue Treatment

Obtain baseline vital signs. (Pulse, respirations and blood pressure)

Gather a SAMPLE history.

Manage secondary injuries and wounds appropriately.

Transport

Perform a Detailed Physical Exam.

Perform Ongoing Assessment.

Objective: The examinee will demonstrate knowledge of the appropriate steps for a trauma patient assessment.

31

Patient Interview/Assessment and General Event Flow

On scene/scene survey

BSI precautions (PPE)

Scene safety

Additional resources

Number of patients

Type of patient(s), medical or trauma. If trauma determine need for cervical spine precautions

Pre-contact impressions

What is the nature of the event (trauma, (example-vehicle accident) or medical (example-seizure) or both (example-vehicle accident with seizure)

Visual impressions of the patient o Conscious/unconscious o ABC’s o Skin signs o “Big sick/little sick”

Initial Patient Contact

Conscious patient o If trauma is suspected take initial c-spine precautions while making introduction o Introduce yourself and let the patient know:

Who you are (your name, “Hi, my name is _______.”) Your position (“I’m an EMT,” or “I’m an emergency medical technician,”

or a phrase that will denote your competence, credibility and authority.) Why you are with the patient (“I’m here to help,” and/or, “you called us

today,” etc.) o Obtain chief complaint (“Why did you call us today?” “How can we help you

today?” “What happened?” Etc.) o Update General Impression (“Big sick/little sick.”) o Conscious patient intro example: “Hi, my name is _______, I’m an EMT-medic

and I’m here to help you. Can you tell me why you called us? OK. I’m going to ask you a few basic questions so that we can continue to help you.”

o Level of Consciousness (LOC) Person, place, time and purpose or event

o Start SAMPLE and physical exam o Prepare for transport (NOTE: Criteria for immediate transport (“load and go”)

are unconscious patient, uncontrolled bleeding, complications of childbirth and severe spinal injuries.)

o Treat patient as indicated during interview/assessment process

32

Initial Patient Contact

Unconscious patient o ABC’s o LOC (AVPU) o If trauma is suspected take initial c-spine precautions o Determine chief complaint if possible o Introduce yourself to bystanders, family members, etc if appropriate, and let

them know: Who you are (your name) Your position (I’m an EMT or I’m an emergency medical technician or a

phrase that will denote your competence, credibility and authority.) Why you are with the patient (“I’m here to help,” and/or, “someone

called us today,” etc.) Did you see (the patient) lose consciousness? And person, place, time

and purpose or event if possible. o Unconscious patient intro example: “My name is _______, I’m an EMT-medic

and I’m here to help. Did anyone see what happened? Does anyone know this person? Are you a family member? Do you know anything about this person’s medical history? OK. Please tell me what you know so we can help.”

o Update General Impression (“Big sick/little sick.”) o Prepare for transport (Criteria for immediate transport (“load and go”) are

unconscious patient, uncontrolled bleeding, complications of childbirth and severe spinal injuries.)

o Start SAMPLE, physical exam and look for medical alert bracelets or medallions o Treat patient as indicated during interview/assessment process

SRT Actions

The lead EMT is the primary authority and will be responsible for patient contact, obtaining

information from the patient, and for directing the SRT. Typical assignments taken by SRT

members and usually not by the lead EMT will include:

Vital signs

Documentation - Fill in the Transfer of Care worksheet by recording pertinent information in all data fields including time of action for 02 administration, all vital signs, etc. Documenter will also prepare the Refusal of Service information sheet (AMA) but the lead EMT will present it to the patient.

Airway management – Prepare 02 administration as directed by the lead EMT.

Trauma management – Prepare c-spine precautions, back boarding and strapping as directed by the lead EMT.

Communications – Interface with incoming ALS personnel and/or other contacts as needed. (Dispatch, hospital, law enforcement, fire personnel, etc.)

33

Patient Report

When relieved by a higher medical authority or when transferring care, the lead EMT will give a

full report on the patient to include:

patient’s age

gender

what happened and chief complaint

actions taken by the SRT

SAMPLE information as necessary.

Report Examples

#1 (Medical patient) – “We were presented with a 59 year old female who’s chief complaint is

dizziness, and who said she was, “feeling faint.” Patient has a history of low blood pressure and

is currently seeing a doctor for it. She wasn’t doing anything unusual when the episode

occurred. Patient states that she has no allergies that she is aware of. We took a full set of vitals

and her blood pressure was 110/60 at 1015. We administered high flow 02 through a non-

rebreather mask at 15 liters per minute. We gathered the patient’s medications and put them in

this Ziploc baggie for you. Patient ate a normal breakfast and is not feeling nauseous. She agrees

that it would be best for her to be transported to the hospital and be seen by a doctor. Full

documentation is on the transfer of care worksheet. We’re ready to help you load the patient

for transport.

#2 (Trauma patient) –We arrived on scene of a single vehicle accident; a car hit this telephone

pole head on. We have one patient, the driver. There was no airbag deployment and he wasn’t

wearing a seat belt. He’s unconscious and breathing, and has traumatic injuries to the head from

hitting the windshield, and the chest from impacting the steering wheel. We’ve taken full c-

spine precautions. Patient is immobilized on a back board and packaged for immediate

transport. Patients pulse is weak and thready at 140 beats per minute. Breathing is shallow and

rapid. We are assisting with respirations through a BVM on high flow 02 at 15 liters per minute.

Full documentation is on the transfer of care worksheet. We’re ready to help you load the

patient for transport.

Cabrillo College EMT Training Program Neurological Exam



34


C-spine Precautions

Indicate that this would be done now if not done earlier (as needed).

Assess Level of Consciousness (LOC) using AVPU

Is the patient alert? (A) Is the patient oriented? (O) Ask the patient:

“What is your name?” (A&Ox1), “Where are you?” (A&Ox2),

“What time or day is it?” (A&Ox3), “What happened to you?” (A&Ox4)

If not alert, is the patient responsive to:

Verbal stimuli? (V), Painful stimuli? (P), Unresponsive? (U)

Assess Pupils using PERL

Check for size.

Check for equality.

Check for roundness and regularity.

Check for reactivity to light.

Assess Extremity Perfusion, Motor Function and Sensation (PMS)

Assess upper extremities for distal pulses (presence and equality), movement (presence and

equality of grip) as well as sensation in fingers, and capillary refill.

Assess lower extremities for distal pulses (presence and equality), movement (presence and

equality of strength) as well as sensation in toes, and capillary refill.

Describe Findings Verbally

Level of consciousness

Pupils

Distal PMS

Objective: The examinee will demonstrate the ability to properly conduct a neurological exam and verbalize the results to the proctor.

Equipment: Penlight, patient.

Cabrillo College EMT Training Program Bleeding Control and Shock Management



35


Apply Direct Pressure

Apply direct pressure to the wound with 4x4s. In cases of profuse bleeding, do not waste time

finding a dressing – use your gloved hand to apply direct pressure immediately. Apply 4x4s

when you can.

Expose injury site.

Elevate extremity

Elevate the injury to above the level of the heart.

If the wound continues to bleed, apply additional dressings over the first one.

Do not remove a dressing

once it has been applied.

Pressure Point

If a wound continues to bleed, apply firm, direct pressure at the appropriate pressure point.

Pressure Dressing

Apply pressure bandage over the dressing.

Assess distal circulation to ensure bandage was not applied too tight.

The patient is showing signs of shock. What should you do?

Position patient supine with feet elevated.

Apply high flow oxygen.

Cover patient with blanket to prevent heat loss.

Prepare for immediate transport.

Reassess

Check for presence of radial pulse.

Note skin signs of patient.

Check capillary refill time.

Objective: The examinee will demonstrate proficiency in controlling bleeding.

Equipment: 4x4s, cling wrap.

Cabrillo College EMT Training Program Combat Application Tourniquet (C-A-T)



36


Indications for Tourniquet Use

Tourniquets are used to control bleeding when:

Life-threatening limb hemorrhage is not controlled with direct pressure or other simple

measures

Traumatic amputation has occurred

Used only on an arm or a leg

Application

Expose the extremity proximal to the injury.

Slide the wounded extremity through the loop of the C-A-T, or route the band around the limb

and pass the red tip through the inside slit of the buckle.

Locate the C-A-T directly over exposed skin 2-4 inches proximal to the injury.

Pull the band tight and pass the red tip through the outside slit of the buckle.

Pull the band very tight and securely fasten the band back on itself with the Velcro fastener.

Twist the rod until bright red bleeding has stopped and the distal pulse is eliminated.

Place the rod inside the clip locking it in place.

Check for bleeding and distal pulse. If bleeding is not controlled, apply a second tourniquet

proximal to the first and reassess.

Secure the rod inside the clip with the strap.

When the band is pulled

tight, no more than three

fingers will fit between

the band and the limb.

Transport Patient

Mark the patient’s head with the letter “T”, time of application and location of the C-A-T.

Prepare patient for transport.

Reassess bleeding.

Do not remove, cover or

loosen the C-A-T.

Objective: The examinee will demonstrate proficiency in performing application of Combat Application Tourniquet.

Equipment: Manikin, C-A-T.

Cabrillo College EMT Training Program Joint Immobilization



37


Prepare the Patient

Explain the splinting procedure to the patient.

Assess distal pulse, motor function and sensation (PMS) prior to immobilization.

Direct second rescuer to apply manual stabilization of the bones adjacent to the injured joint.

Expose affected area.

Immobilize the Joint

Select appropriate splinting material.

Position splint in place under the injured joint. Pad as necessary.

Secure splint in place with cravats, cling wrap, or other fasteners.

Be sure to support the

bone ends while

positioning the splint.

Reassess

Reassesses distal pulse, motor function and sensation (PMS).

Objective: The examinee will demonstrate how to properly immobilize an injured joint.

Equipment: Splinting material, cravats, cling wrap, fasteners, patient.

Cabrillo College EMT Training Program Long Bone Immobilization



38


Prepare the Patient


Assess bilateral distal pulse, motor function and sensation (PMS) prior to immobilization.

Direct second rescuer to apply manual stabilization of the extremity.


Immobilize the Injured Extremity

Measure splint to several inches beyond both joints above and below the injury.


Position splint in place.

Secure splint in place with cravats, cling wrap, or other fasteners.

Measure on opposite

extremity if possible.


bone ends while


Reassess


Objective: The examinee will demonstrate how to properly immobilize an injured long bone.


Cabrillo College EMT Training Program Bandaging and Splinting an Open Extremity Fracture



39


Prepare the Patient


Assess distal pulse, motor function and sensation (PMS) prior to immobilization.

Direct second rescuer to apply manual stabilization of the extremity without applying traction.


Dress the Wound

Apply appropriate dressing to the wound.

Immobilize the Injured Extremity

Measure splint to several inches beyond both joints above and below the injury.


Support fracture site while applying splint.

Pad splint where needed.

Secure splint in place above and below injure with cravats, cling wrap, or other fasteners.

Measure on opposite

extremity if possible.


bone ends while


Reassess


Objective: The examinee will demonstrate how to properly bandage and splint an open extremity fracture.


Cabrillo College EMT Training Program Sling and Swathe Immobilization



40


Prepare the Patient

Explain the splinting procedure to your patient, gaining their consent to apply a sling and

swathe.

Direct a second rescuer (if available) to apply manual stabilization of the bones above and

below the injury site.

Assess bilateral distal pulse, motor function and sensation (PMS).

Apply Sling

Position triangular bandage under the injured arm with the acute angle of the bandage over the

uninjured shoulder and the right angle of the bandage at the elbow of the injured arm.

Bring the lower portion of the bandage up over the injured arm and over the shoulder on the

same side.

If you do not suspect a spinal injury, draw up the ends of the bandage until the hand is several

inches above the elbow.

Tie the two ends of the sling together.

Reassess bilateral distal pulse, motor function and sensation (PMS).

Apply Swathe

Immobilize the shoulder girdle and upper extremity by tying a swathe around the chest and

injured arm with another bandage.

A pillow or pad can be

placed under the arm for

comfort.

Reassess

Reassess bilateral distal pulse, motor function and sensation (PMS).

Be sure the device does

not constrict distal

circulation.

Objective: The examinee will demonstrate proficiency in applying a sling and swathe.

Equipment: Simulated patient, triangular bandages.

Cabrillo College EMT Training Program Kendrick Extrication Device (KED)



41


Immobilize patient’s head and neck from front or side. Introduce yourself. Request permission to

treat. Instruct helper to position self behind patient and take over manual C-spine.

Assess for perfusion, motor function and sensation (PMS)

Check for capillary refill time and radial pulse.

Ask patient to grip the index and middle fingers of each of your hands simultaneously.

Ask patient which finger is being touched as you apply pressure.

Assess neck and back for injury and pain and places C-collar on patient

Palpate midline of neck for point tenderness and ask if they have any neck pain.

Palpate midline of back for point tenderness and ask if they have any back pain.

Measure and select proper size of C-collar. Secure collar in place.

Place KED behind patient

Assist patient to lean forward from waist using one hand to support chest and direct helper to

maintain spinal alignment.

Slide KED into place and position snuggly under armpits.

Secure straps

Secure torso straps without excessive movement and without causing respiratory compromise.

Secure leg straps.

Order of torso straps is

not important.

Pad and Secure head

Place padding in gaps between KED and patient’s head as needed.

Secure patient’s head to KED with forehead strap and chin strap.

Reassess

Instruct helper to release patient’s head. Recheck perfusion, motor function and sensation of

patient.

State: “While placing patient on long board they would be moved by supporting legs and

using side straps. Full backboard immobilization procedures using straps, head bed and

tape would be used. Leg straps of KED would be loosened prior to backboard strapping.”

Objective: The examinee will place and secure a KED on a sitting patient.

Equipment: Simulated patient and KED device.

Cabrillo College EMT Training Program Helmet Removal



42


Stabilize the Patient

Approach the patient from front and instruct them not to move.

Direct second rescuer to maintain manual stabilization at the top of the patient’s head, holding

the helmet stable, with palms on the sides of the helmet and fingers on the jaw.

Evaluate bilateral distal pulse, motor function and sensation (PMS) in all extremities.

Gain consent to treat the

patient.

Remove Helmet

Open, remove or cut the chinstrap.

Assume manual stabilization from the second rescuer by placing one hand on the occiput

behind the patient’s head and another on the mandible. The second rescuer can now release

manual stabilization to you.

Direct the second rescuer to slowly remove the helmet by pulling out the sides so that they

clear the ears.

Maintain Stabilization

Manual stabilization should be maintained throughout the entire process.

A cervical collar should be applied and full spinal immobilization completed when possible.

Reassess

Reassess bilateral distal pulse, motor function and sensation (PMS) in all extremities.

Objective: The examinee will demonstrate proper helmet removal.

Equipment: Helmet, patient, c-collar.

Cabrillo College EMT Training Program Lifting and Moving Patients



43


Consider the patient to be moved, the need for additional assistance and the physical abilities of

those available to help with the move. A plan must then be formulated and communicated.

Follow Proper Body Mechanic Rules

Position your feet correctly.

Use your legs, not your back, to lift.

Never twist or turn.

Keep back straight, do no compensate when lifting with one hand.

Keep the weight close to your body.

Use a stair chair when carrying a patient on stairs.

Select the proper carry for the situation at hand.

Objective: The examinee will demonstrate proper lifting and moving of patients.

Cabrillo College EMT Training Program Spine Immobilization Supine Patient



44


Prepare Patient

Direct second rescuer to maintain patient’s head in neutral, in-line position.

Assess distal pulse, motor function and sensation (PMS) in extremities.

Apply properly fitted cervical collar.

Maintain manual c-spine

until patient’s head is

secured to the spine

board.

Place Patient

Position a long spine board parallel to patient.

Roll patient onto their side without movement of the spine.

Pull the spine board under the patient.

Roll patient back to supine position on top of the spine board.

Move patient to proper position on the device as a unit.

Rescuer holding c-spine

directs each movement of

the patient.

Secure Patient

Pad any voids between torso and the board as necessary.

Secure the patient to the spine board, placing straps across the upper chest, pelvis and ankles.

Evaluate and pad under the patient’s head as necessary.

Secure the patient’s head to the board using a “Head Bed” type device, finishing with tape

across the forehead, fastening the ends directly to the board.

Secure the arms of the patient to prevent injury.

Make sure the patient’s

arms are left free when

strapping the upper chest.

Reassess

Reassess distal pulse, motor function and sensation (PMS) in extremities.

Objective: The examinee will demonstrate proper spine immobilization of a supine patient.

Equipment: C-collar, long board, straps, head-bed, tape.

Cabrillo College EMT Training Program Spine Immobilization Standing Patient



45


Prepare Patient

Direct second rescuer to maintain patient’s head in neutral, in-line position from behind the

patient.

Explain the procedure to the patient.

Assess distal pulse, motor function and sensation (PMS) in extremities.

Apply properly fitted cervical collar.

Maintain manual c-spine

until patient’s head is

secured to the spine

board.

Place Patient

Position immobilization device against patient’s back, between the arms of the rescuer holding

manual stabilization.

Two rescuers position themselves on either side, facing the patient, holding immobilization

device under the arms of the patient.

Lower the immobilization device by taking synchronous steps forward and extending arms

until the board reaches the ground.

Move patient to proper position on the device as a unit.

Rescuer holding c-spine

directs each movement of

the patient while ensuring

that the head remains in a

neutral position to the

board.

Secure Patient

Pad any voids between torso and the board as necessary.

Secure the patient to the spine board, placing straps across the upper chest, pelvis and ankles.

Evaluate and pad under the patient’s head as necessary.

Secure the patient’s head to the board using a “Head Bed” type device, finishing with tape

across the forehead, fastening the ends directly to the board.

Secure the arms of the patient to prevent injury.

Make sure the patient’s

arms are left free when

strapping the upper chest.

Reassess

Reassess distal pulse, motor function and sensation (PMS) in extremities.

Objective: The examinee will demonstrate the proper takedown and spine immobilization of a standing patient.

Equipment: C-collar, long board, straps, head-bed, tape.

Cabrillo College EMT Training Program Application of Soft Restraints



46


Plan your actions ahead of time.

At least four people are required to restrain a patient. Each person should be pre-assigned a

limb to restrain. Rescuers should act all at once to overwhelm the patient.

Grab clothing or large joints. Avoid placing pressure on the neck or chest. Avoid the mouth,

as some patients may try to bite rescuers.

Reassure the patient throughout the procedure.

Secure the patient on the ambulance gurney in a supine or lateral position.

If the patient is spitting at rescuers, a surgical mask or non-rebreather mask (connected to an

O2 source) can be placed over the patient’s face.

Continually monitor distal circulation in restrained extremities.

Once restrained, do not leave the patient at any time. Consider having extra personnel in the

ambulance’s patient compartment during transport.

Monitor ABCs during transport.

Do not remove restraints unless sufficient personnel are available to control the patient.

Objective: The examinee will demonstrate knowledge in the application of soft restraints.

Cabrillo College EMT Training Program Rapid Extrication



47


Position a rescuer in the rear seat and maintain c-spine immobilization

Perform in initial assessment of the patient to assure that this is a high priority patient and this

is the most appropriate extrication technique to use.

Apply the c-collar and make sure the other three rescuers are properly positioned. One on

each side of the patient and one outside the vehicle ready with the long backboard.

Carefully start the quarter turn until the rescuer holding c-spine is unable to turn any further -

then stop the turn.

Carefully transfer the c-spine immobilization to a rescuer outside the vehicle and on their

command complete the quarter turn so that the patient is now seated on the backboard

perpendicular to the steering wheel.

Lay the patient down onto the backboard making sure that c-spine immobilization is always

maintained and the chest and armpits are fully supported.

Upon the command of the rescuer holding c-spine, slide the patient into position on the

backboard.

Carefully remove the patient on the backboard from the vehicle.

Perform an appropriate physical exam.

Apply the torso, hip and lower leg straps and then a “Head Bed” type device.

Complete the assessment of PMS and any other additional assessment and management prior

to transport.

Objective: The examinee will demonstrate proficiency in performing a rapid extrication along with additional rescuers.

Equipment: Auto, simulated patient, long backboard with straps, c-collar, assistants.

Cabrillo College EMT Training Program Administration of Glucose



48


Preparation

Consult medical control.

Check medication for its expiration date.

Reconfirm the five rights of drug administration:

right patient, right drug, right dose, right route and right time.

Confirm the patient’s ability to swallow and the presence of a gag reflex.


Administration

Open tube while keeping it clean.

Apply glucose by squeezing tube onto tongue depressor.

Insert tongue depressor with glucose into their mouth, between the cheek and the gum, or

under their tongue.

Remove the tongue depressor.

Confirm that the patient can swallow.

Reapply glucose to tongue depressor and continue the administration until the glucose is gone

from the tube.

Immediately discontinue administration if the patient loses the ability to swallow or becomes

unresponsive, and consult with medical control as soon as possible.

In some cases, the patient

could self-administer the

glucose.

Reassess

Reassess the patient’s vital signs and monitor their response to treatment.

Objective: The examinee will demonstrate the proper administration of glucose to a patient.

Equipment: Glucose, tongue depressor, patient.

Cabrillo College EMT Training Program Administration of Nitroglycerin



49


Preparation


Check medication for its expiration date, and ask the patient when the container was first

opened. Inquire about how the medication has been stored.

Find out when the patient last took nitro, and if they have taken any drugs for erectile

dysfunction in the last 24 hours.



Confirm patient’s systolic blood pressure is greater than 100mm Hg.


Remove the oxygen mask.

Do not administer

nitroglycerin if systolic

pressure is less than

100mm Hg, or if patient

has taken an erectile

dysfunction drug in the

last 24 hours.

Administration by Tablet

Ask patient to open mouth and to lift tongue.

Place tablet under the patient’s tongue. Ask them to let the nitro dissolve under their

tongue and to not swallow for a few minutes.

Administration by Spray

DO NOT shake canister.

Ask patient to open mouth and to lift tongue.

Spray on or under tongue.

Ask patient to wait at least 10 seconds before swallowing.

Reassess

Retake the patient’s blood pressure within two minutes.

Monitor patient’s response to treatment.

If pain persists after five minutes or if systolic pressure drops to below 100mm Hg consult

with medical control or local policies.

Some EMS systems allow multiple doses to be administered.

If patient becomes light

headed, less responsive

or their blood pressure

drops, immediately place

the patient in shock

position.

Objective: The examinee will demonstrate the proper administration of nitroglycerin to a patient.

Equipment: Nitroglycerin, sphygmomanometer, stethoscope, O2 mask, patient.

Cabrillo College EMT Training Program Epinephrine Auto-Injector



50


Preparation






Administration

Remove the cap from the auto-injector.

Expose the thigh area. Some auto-injectors will work through clothing.

Place auto-injector device on the lateral thigh midway between the knee and the waist.

Tell patient they may feel a stick from the needle.

In a smooth, direct, 90-degree angle, push the injector firmly until you hear the device inject

the needle.

Hold for 10 seconds to allow medication to be delivered.

Remove auto-injector.

Rub the injection site for 10 seconds.

Dispose of the auto-injector appropriately.

The spring-loaded device

needs a good amount of

pressure against the

thigh. Make sure you are

pressing hard enough.

If at any time a needle

sticks you or anyone,

consult your policies and

procedures immediately.

Reassess


Objective: The examinee will demonstrate the proper administration of epinephrine via an auto-injector (EpiPen).

Equipment: EpiPen trainer, patient.

Cabrillo College EMT Training Program Administration of Nebulized Medication



51


Preparation





Assess the patient’s ability to use the nebulizer.


The patient should be

conscious and oriented

enough to be able to

assist with the

administration of the

medication.

Assemble the Nebulizer

Unscrew the lid of the nebulizer chamber, add medication as directed and reattach lid.

Fasten the T-tube to the nebulizer chamber.

Connect the mouth piece to one end of the T-tube and the flex tube to the other end.

Attach oxygen connecting tubing from nebulizer to O2 source. Adjust oxygen flow to six liters

per minute. You should be able to see a mist coming out of both the flex tube and the

mouthpiece.

Administration

Ask the patient to sit as upright as possible.

Ask the patient to hold the nebulizer in their hand and to place the mouthpiece firmly in their

mouth. Lips should be sealed tightly around the mouthpiece. Ask them to breathe deeply and

slowly, through their mouth.

At times it may be necessary to shake the chamber slightly to remove medication attached to

the wall of the chamber.

Continue this treatment until the full amount of the medication is gone.

It is important to direct

the patient to take deep

and slow breaths. This

allows the medication to

be absorbed.

Reassess


Objective: The examinee will demonstrate the proper administration of nebulized medication to a patient.

Equipment: Nebulizer, O2 source, patient.

Cabrillo College EMT Training Program Administration of Activated Charcoal



52


Preparation






Activated charcoal has

many contraindications

for its use. Knowing these

contraindications is

important.

Administration

Determine the correct dose.

Shake the container thoroughly.

Place mixture into a covered container with a straw.

Let the patient know the medication does not taste good, and has a gritty texture.

Ask the patient to take medication.

The patient needs to take the complete amount of the medication as prescribed.

The use of a covered

container keeps the

patient from seeing the

medication and getting

negative feelings.

Reassess


Objective: The examinee will demonstrate the proper administration of activated charcoal to a patient.

Equipment: Activated charcoal, covered container, patient.

Cabrillo College EMT Training Program Metered Dose Inhaler



53


Preparation






Administration

Shake the canister vigorously for about 30 seconds.

If the patient has an oxygen mask on, remove the mask for the procedure.

Instruct the patient to put the inhaler in their hand and to hold it upright.

Instruct the patient to take a deep breath and to exhale fully.

Quickly have the patient place their lips around the mouthpiece, making a tight seal with their

lips.

Have the patient take a deep and slow breath over a five-second period. Simultaneously the

patient or you depress the canister. Make sure the patient has started the inhalation before the

canister is depressed.

Remove the inhaler and request that the patient hold their breath for up to 10 seconds if able.

Coach the patient to exhale slowly with pursed lips.

Administer oxygen to patient if needed.

Repeat second dose if so indication by medical control.

Timing is everything in

the delivery of medication

by the inhaler. You must

make sure that the

inhalation and the

depression of the canister

are timed effectively to

ensure the medication

will be absorbed.

Reassess


Objective: The examinee will demonstrate the proper administration of a metered dose inhaler to a patient.

Equipment: Metered dose inhaler, patient.

Cabrillo College EMT Training Program Medical Patient Assessment



54



Is the scene safe? What is the nature of illness (NOI)? What is the number of patients? What

additional resources do I need? Do I need to take C-spine precautions?

Initial Assessment




ABCs




Responsive Patient

Determine the history of the present illness.


Perform a Focused Physical Exam based on the chief complaint.

Obtain baseline vital signs.

Transport.

Unresponsive Patient

Perform a Rapid Physical Exam.


If possible: (Ask family members or bystanders, look for evidence on scene, etc.)

Determine the history of the present illness.


Transport.

Remember AEIOUTIPS

for determining possible

causes of altered level of

consciousness.

Perform Ongoing Assessment.

Objective: The examinee will demonstrate knowledge of the appropriate steps for a medical patient assessment.

Cabrillo College EMT Training Program Adult and Child One-Rescuer CPR



55


Check for response

Check for no breathing or no normal breathing (minimum 5 seconds, maximum 10 seconds)

Activate emergency response system and call for an AED

Check carotid pulse (minimum 5 seconds, maximum 10 seconds)

Locate CPR hand position

Deliver first cycle of compressions at correct rate (>100 compressions per minute)

Acceptable:

30 compressions in less

than 18 seconds

Give two breaths (one second each)

Deliver second cycle of compressions at correct rate and hand position


Deliver third cycle of compressions of adequate depth with full chest recoil


Objective: The examinee will demonstrate proficiency performing CPR.

Equipment: CPR manikin, BVM or Pocket Mask.

Cabrillo College EMT Training Program One-Rescuer CPR with Automatic External Defibrillator


56


You observed a person collapse on the floor. You arrive at the patient’s side with an AED. No

one is performing CPR. It has been less than 2 minutes since the person collapsed.

Assess

Place patient in a supine position on a dry surface.

Check for responsiveness.

Check breathing for minimum of 5 and a maximum of 10 seconds.

Activate EMS.

Check carotid pulse for minimum of 5 and a maximum of 10 seconds.

Assess if patient is a candidate for the use of an AED. State to proctor, “AEDs may be used

on patients who are unconscious, unresponsive with no pulse.”

Prepare AED

Turn on AED.

Place pads on patient’s chest. Sternum pad is placed upper anterior right side of chest just

below the clavicle. Apex pad is placed on the left side of the chest below the breast and

toward the lateral aspect of the ribs as shown by the pad diagrams.

Confirm electrodes are plugged in.


Cabrillo College EMT Training Program One-Rescuer CPR with Automatic External Defibrillator



57


Analyze

Clear patient to analyze. Must be a visible check and then state “Everyone clear!”

Analyze patient by pushing the analyze button.

Some AEDs do not

have an analyze button

and analyze

automatically.

Shock Advised

Visually check that no one is touching the patient at the time shock is delivered. State, “I’m

clear, you’re clear, everyone clear!” as you observe the patient prior to patient being

shocked.

Press SHOCK button.

Immediately initiate CPR beginning with chest compressions.

Complete 5 rounds of chest compressions and ventilations.

Return to Analyze

Maximum time from

arrival at patient’s side

to shock 100 seconds.

No Shock Advised

Check pulse.

If no pulse initiate CPR beginning with chest compressions. Complete 5 rounds of chest

compressions and ventilations. Return to Analyze

If patient has a pulse, check breathing. If breathing is adequate, provide oxygen via a non-

rebreather mask. If breathing is inadequate or absent, ventilate the patient at the appropriate

rate.

Objective: The examinee will demonstrate proficiency performing CPR with an AED on a manikin.

Equipment: Manikin, AED, BVM or pocket mask.

Cabrillo College EMT Training Program Infant One- and Two-Rescuer CPR



58


Check for response

Check for no breathing or no normal breathing (minimum 5 seconds, maximum 10 seconds)

Activate emergency response system and call for an AED

Check brachial pulse (minimum 5 seconds, maximum 10 seconds)

Locate CPR finger position

Deliver first cycle of compressions at correct rate (>100 compressions per minute)

Give two breaths (one second each) with visible chest rise

Repeat for a total of five cycles

Acceptable:

30 compressions in less

than 18 seconds

Recheck for a pulse

Proctor will act as a second rescuer and take over at airway

Deliver first cycle of compressions using the thumbs-hand encircling the chest technique at the

correct rate (>100 per minute) and ratio (15:2)

Pause to allow the proctor to give two breaths (one second each)

Repeat for a total of two cycles

Proctor states “After two minutes you assess the infant and there is a pulse, but the baby is not

breathing. Demonstrate what you need to do.”

Give breaths (one second each) at the correct rate (every three to five seconds) with the majority

of ventilations resulting in visible chest rise.

Objective: The examinee will demonstrate proficiency performing infant one- and two-rescuer CPR.

Equipment: Infant CPR manikin, BVM or pocket mask, second rescuer.

Cabrillo College EMT Training Program Adult and Child Foreign Body Airway Obstruction: Unresponsive Patient



59


Establish Unresponsiveness

Gently shake and shout, “Are you OK?”

If you are not alone send someone to activate EMS, and then continue the airway obstruction

sequence.

If you are alone with an Adult victim, activate EMS, and then continue the airway obstruction

sequence.

If you are alone with a Child victim, activate EMS after you have either relieved the

obstruction or you have attempted the airway obstruction sequence for 2 minutes.

Airway Obstruction Sequence

Open the airway.

Remove objects from the mouth if they are visible.

Attempt to ventilate.

If unable to ventilate, reposition patient’s head and attempt to ventilate again.

If unable to ventilate, perform CPR.

Every time you open the airway to give breaths, open the victim’s mouth wide and look for the

object. If you see an object, remove it. If you do not see an object, keep doing CPR.

Objective: The examinee will demonstrate the proper sequence for an obstructed airway on an unconscious patient.

Equipment: Adult CPR manikin, mat.

Cabrillo College EMT Training Program Adult and Child Foreign Body Airway Obstruction: Responsive Patient



60


Airway

Ask the victim, “Are you choking?”

Determine whether complete airway obstruction is present:

If the victim can talk or is coughing, it is a partial airway obstruction. Encourage them

to cough forcefully to dislodge the obstruction.

If the victim cannot cough, has a very weak cough, or is cyanotic, treat the patient as if

there is a severe airway obstruction and begin abdominal thrusts.

Perform abdominal thrusts

Position yourself behind the victim.

Make a fist, and place the thumb side of this fist against the midline of the patient’s abdomen

between waist and rib cage.

Grasp your properly positioned fist with your other hand and apply pressure inward and up

toward the patient’s head in a smooth, quick movement. Each thrust should be distinct and be

delivered with the intent of relieving the airway obstruction.

Give five abdominal thrusts.

Avoid the xiphoid

process.

If patient is pregnant or

obese position your fist

and hand on the midline

of the sternum three

fingers above the xiphoid

process.

Reassess

If the obstruction is not relieved after a series of five thrusts, reassess your position and the

patient’s airway.

Repeat the sequence of thrusts and assessments until the obstruction is relieved or the patient

loses consciousness.

Objective: The examinee will demonstrate the Heimlich maneuver for an obstructed airway on a responsive patient.

Equipment: Adult CPR manikin or simulated patient.

Cabrillo College EMT Training Program Infant Foreign Body Airway Obstruction



61


Performance Steps

Student states, “some of the signs of severe airway obstruction are: poor or no air

exchange, weak, ineffective cough, high-pitched sounds while inhaling, turning blue,

unable to cry or make sounds, unable to move air”.

Airway Maneuver

Kneel or sit with the infant in your lap. If easy to do, bare infant’s chest.

Hold infant face down with head slightly lower than the chest, resting on you forearm.

Support head and jaw with your hand.

Deliver up to five back slaps forcefully between the infant’s shoulder blades, using the heel of

your hand.

Place your free hand on the infant’s back, supporting the back of the infant’s head with the

palm. Turn the infant as a unit while carefully supporting the head and neck. Hold the infant

on his back with your forearm resting on your thigh. Keep the infant’s head lower than the

trunk.

Provide up to five quick downward chest thrusts in the same location as chest compressions –

just below the nipple line.

Assess

Repeat until the object is dislodged or the victim becomes unresponsive. Do not perform

blind finger sweeps because the foreign body may be pushed back into the airway

causing further obstruction or injury.

If the infant becomes unresponsive, stop back slaps and begin CPR.

CPR will have one extra

step: each time you open

the airway, look for the

obstructing object in the

back of the throat. If you

see an object, remove it.

Objective: The examinee will demonstrate how to relieve a foreign body airway obstruction in both the conscious and unconscious

infant.

Equipment: Infant manikin.

Cabrillo College EMT Training Program Endotracheal Tube BVM Ventilation



62


Attach BVM to end of endotracheal tube.

Ventilation

Ventilate patient 8-10 breaths per minute or track unconscious breathing patient’s ventilations.


Assess tube placement by watching for chest rise.

Listen for bilateral breath sounds over chest and epigastrium.

Objective: The examinee will demonstrate how to ventilate an intubated patient.

Equipment: Adult airway manikin, #7 ET tube, stylette, laryngoscope and blade, 10cc syringe, adult ET holder, BVM

Cabrillo College EMT Training Program Artificial Ventilation of a Stoma Breather



63


Preparation

Remove any items of clothing from the area of the stoma.

Clear the stoma of any obvious mucous plugs or secretions.

Leave the patient’s head and neck in a neutral position.

Ventilation

Select a mask, most often a pediatric mask that fits securely over the stoma and can be sealed

against the neck.

Hold the mask seal with your hand and ventilate the patient at the appropriate rate for their

age.

Assess the effectiveness of ventilations. Watch the chest for chest rise and fall.

Consider auscultation as

soon as possible to

ensure ventilations.

Problems

If no chest rise, suspect a partial laryngectomy. Seal the nose and mouth with one gloved hand

by placing the palm over the lips and pinching the nose between the third and fourth fingers.

Continue ventilations.

If unable to artificially ventilate through the stoma, consider sealing the stoma and ventilation

through the mouth/nose.

Objective: The examinee will demonstrate proper artificial ventilation of a stoma breather.

Equipment: Manikin with stoma, BVM with pediatric mask.

Cabrillo College EMT Training Program Suctioning Through an Endotracheal Tube



64

Objective: The examinee will demonstrate the proper procedure to suction through an endotracheal tube.

Equipment: Adult airway manikin, ET tube, suction device, soft catheter, sterile gloves, BVM with O2 attached.


Preparation

Explain the procedure to the conscious patient.

Check and assemble the suction device.

Preoxygenate the patient by providing ventilations with 100% O2 for two minutes.

Approximate the length of the catheter to be inserted.

Clean the end of the endotracheal tube where the soft catheter will be inserted with an alcohol

wipe.

Place suction unit near head of patient and turn the unit on.

Attach the sterile soft catheter using a sterile gloved hand.

The suction catheter must

be kept sterile during this

entire procedure.

Suctioning

Using the sterile gloved dominant hand, place the soft catheter into the ET tube without

applying suction.

Advance the catheter slowly down the ET tube until it reaches the desired location.

Place your non-dominant thumb over the hard plastic hole at the proximal end of the catheter

and apply suction.

Slowly withdraw the catheter using a twisting motion.

Clean the catheter in sterile water to remove debris and/or fluids.

If the patient gags during

this procedure stop the

advancement.

Never suction, or

interrupt ventilation for

more than 15 seconds.

Hyperventilate the patient and repeat the procedure if necessary.

Cabrillo College EMT Training Program Suctioning a Stoma



65


Preparation

Explain the procedure to the conscious patient.

Check and assemble the suction device.

Place sterile saline solution in a sterile cup.

Draw up 3 – 5 mL of sterile saline in a 5 mL syringe.

Preoxygenate the patient by providing ventilations with 100% O2 for two minutes.

Approximate the length of the catheter to be inserted.

Place suction unit near head of patient and turn the unit on.

Attach the sterile soft catheter using a sterile gloved hand.

The suction catheter

must be kept sterile

during this entire

procedure.

Suctioning

Using the sterile gloved dominant hand, insert the catheter into the stoma opening until resistance is felt.

Apply suction and slowly withdraw the catheter using a twisting motion.

Re-oxygenate the patient by providing several ventilations with 100% O2.

Suction no longer than 10

seconds for adults,

3 seconds for children.

Assessment

Reassess breath sounds.

If mucous plugs or thick secretions are still present, instill 3 – 5 mL of sterile saline to help thin secretions prior to suctioning again.

Clean the catheter in sterile water to remove debris and/or fluids.

Repeat the procedure if necessary.

Objective: The examinee will demonstrate proficiency in performing suctioning of a stoma. Equipment: Adult airway manikin with stoma, suction device, soft catheter, sterile gloves, sterile saline, 5 mL syringe, BVM with O2 attached.

Cabrillo College EMT Training Program Medical Patient Assessment-Responsive: Chest Pain


66


Scene Size-up (5 questions)

Is the scene safe? What is the nature of illness (NOI)? What is the number of patients? What

additional resources do I need? Do I need to take C-spine precautions?

Initial Assessment




ABCs




Chest Pain Assessment

OPQRST: Onset: “Did the symptoms come on suddenly or gradually?” Provocation: “Are

there moments (such as during inhalation), or positions where the pain is better or worse?”

Quality: “Describe the pain, what does it feel like?” Region/Radiation: “Point to where it

hurts. Does the pain go anywhere else?” Severity: “On a scale of 1 to 10 with 10 being the

worst pain you have ever felt, what number would you give this pain?” Time: “When did your

chest pain begin?”

SAMPLE History

Signs and symptoms: “What’s wrong?” Allergies: “Are you allergic to medications, foods, or

environmentals?” Medications: “What medications are you currently taking (prescription,

over-the-counter, herbal supplements, or recreational)?” Past pertinent history: “Have you

been having any medical problems? Have you been feeling ill, or had any recent surgery or

injuries? Have you been seeing a doctor (what’s your doctor’s name)?” Last oral intake:

“When did you last eat or drink? What did you have?” Events leading to present illness:

“What sequence of events led up to today’s problem?”


Cabrillo College EMT Training Program Medical Patient Assessment-Responsive: Chest Pain



67


Perform Focused Physical Exam

Look for signs of breathing difficulty, auscultate lung sounds, palpate chest (look, listen and

feel) and check for JVD, surgical scars and pedal edema.

Ask patient if they have nausea, have vomited or feel dizzy.

Ask patient if they are taking medication for erectile dysfunction.


Interventions

Place patient in position of comfort.

Obtain medical direction or verbalize standing order for assisting patient with their own

nitroglycerin if systolic BP is above 100mmHg.

Transport with reassessment and detailed physical exam enroute.

Objective: The examinee will demonstrate proficiency in performing a medical assessment on a patient with cardiac chest pain.

Equipment: Manikin or simulated patient.

Cabrillo College EMT Training Program Emergency Childbirth


68


Assess

Approach patient, introduce self and ask permission to treat.

Ask patient, “Do you feel the need to bear down or move your bowels?” If answer is yes:

Advise patient of your need to examine for crowning.

Observe for crowning to determine if delivery is imminent.

Ask 4 key questions if time permits:

1. “When did your contractions begin?”

2. “How far apart are the contractions?”

3. “Are you expecting any complications with the delivery?”

4. “When is your baby due?”

Preparation

Open OB kit.

Remove patient’s clothing that obstructs vaginal opening.

Drape patient for privacy using sheets leaving vaginal opening exposed.

Cleanse perineum (vaginal area)

Wipe top to bottom, medial to lateral.

Place chux or towels under patient’s hips.

Deliver baby’s head

With one hand, support and apply gentle counter pressure to baby’s head to prevent rapid

birth.

As head emerges make sure the amniotic sac membrane has ruptured. If not, gently puncture

the sac with fingers removing it from the baby’s face.

When the head is out make certain the cord is not around the baby’s neck. If it is, loosen cord

from around baby’s neck and slip cord over the head and shoulders. If you cannot free the

cord from around the neck, clamp the cord in 2 places and cut between the clamps.

Once head is delivered, suction baby’s mouth and then the nose.


Cabrillo College EMT Training Program Emergency Childbirth



69


Deliver the rest of the baby

Apply gentle downward pressure to head to release upper shoulder.

Apply gentle upward pressure on head to release lower shoulder.

Support the head, trunk and pelvis as rest of baby delivers.

Suction baby’s mouth and nose with bulb syringe again to clear secretions out of the airway.

Stimulate baby’s breathing

Flick bottom of baby’s foot. Stroke baby’s back briskly.

Dry and warm the baby and monitor airway and breathing.

Assesses baby’s respiration, color and heart rate.

Wrap baby in a blanket and keep at the same level as the vagina until the umbilical cord stops

pulsating.

Double clamp cord

Place first clamp 10” from baby, second clamp 3” from first (4 fingers width) towards baby.

Cut the cord between the two clamps.

Note the exact time of birth.

Assess baby’s APGAR at 1 minute. Verbalize that APGAR stands for Appearance, Pulse,

Grimace, Activity and Respiratory effort.

Place baby on mother’s abdomen or to mother’s breast.

Deliver placenta and place in plastic bag. Label the bag with “placenta”, mother’s name and time

expelled.

Control vaginal bleeding

Place a sanitary napkin over the mother’s vaginal opening. Do not place anything in the

vagina.

Massage the fundus lightly with a circular motion to control excessive post-partum bleeding.

Assess baby’s APGAR at 5 minutes.

Objective: The examinee will demonstrate proficiency in assisting with an emergency childbirth.

Equipment: Childbirth manikin, neonate manikin with umbilical cord and placenta, OB kit.

Cabrillo College EMT Training Program Hare Traction Splint



70


Prepare the Patient

Determine that the patient is a candidate for a traction splint. Student states “Indications are a

closed mid-shaft femur fracture with no injuries to the proximal hip or distal leg (including

knee).”

Direct assistant to stabilize leg while you expose the thigh and remove shoes and socks.

Explain the procedure to the patient, letting them know that this will alleviate some of the pain

and help prevent further leg injury.


Apply the ankle hitch.

Temporarily take over stabilization of leg and direct assistant to apply and maintain manual

traction.

Prepare Splint

Place splint parallel to uninjured extremity, adjust length 6-8 inches beyond foot and lock.

Position support straps (two above and two below the knee).

Support fracture site while lifting leg and maintaining manual traction.

Place splint under leg, position top portion against ischium.

Splint Leg

Lower leg onto splint.

Place pad under groin strap. Secure groin strap.

Attach ankle strap to splint by rings and turn knob until manual traction is equaled.

Release manual traction.

Position and secure Velcro support straps (two above and two below the knee).

Do not secure a support

strap over the fracture

site.

Reassess

Reassess distal pulse, motor function and sensation (PMS) of the injured leg.

Objective: The examinee will demonstrate proficiency in applying a traction splint.

Equipment: Simulated patient, hare traction splint, small pad for groin strap, assistant.

Cabrillo College EMT Training Program Sager Traction Splint



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Prepare the Patient

Determine that the patient is a candidate for a traction splint.

Direct assistant to stabilize leg while you expose the thigh and remove shoes and socks.

Explain the procedure to the patient, letting them know that this will alleviate some of the pain

and help prevent further leg injury.


Apply the ankle hitch.

Temporarily take over stabilization of leg and direct assistant to apply and maintain manual

traction.

Indications are a closed

mid-shaft femur fracture

with no injuries to the

proximal hip or distal leg

(including knee).

Splint Leg

Position splint medially between the legs with the pulley on the same side and toward the

injured leg.

Secure the hip strap.

Attach ankle strap to splint.

Release the lock and apply mechanical traction. Observe the amount indicated on the traction

scale. It is suggested to use 10% of the patient’s body weight up to 15 pounds.

Release manual traction.

Position and secure Velcro support straps (top of thigh, knee, and ankle).

Do not secure a support

strap over the fracture

site.

Reassess

Recheck distal circulation, sensation and motor function of injured leg.

Objective: The examinee will demonstrate proficiency in applying a traction splint.

Equipment: Simulated patient, Sager traction splint, assistant.

Cabrillo College EMT Training Program Impaled Objects – Penetrating Eye Injury



72


Place patient in supine position.

Control profuse bleeding.

Stabilize the object. Place a roll of three-inch gauze bandage or folded 4x4s on either side of

the object, along the vertical axis of the head in a manner that will stabilize the object.

Apply rigid protection. Fit a disposable paper drinking cup or paper cone over the impaled

object and allow it to come to rest on the dressing rolls. Do not allow it to touch the object.

Do not use a Styrofoam cup, which can flake.

Dress and bandage the uninjured eye. This will help to reduce sympathetic eye movements.

Explain to the patient why you are doing this.

Provide O2 and care for shock.

Objective: The examinee will demonstrate proficiency in immobilizing and bandaging a patient with an impaled object in the eye.

Equipment: Simulated patient, 4x4 pads, paper cup, scissors, tape, bandaging material.

Cabrillo College EMT Training Program Impaled Object Stabilization



73


Do not remove the impaled object.

Expose the wound area, taking great care not to disturb the object.

Long impaled objects may have to be stabilized by hand during exposure, bleeding control and

dressing.

Control profuse bleeding by direct pressure if possible by placing your gloved hands on either

side of the object and exerting pressure downward.

Place several layers of a bulky dressing around the object and tape in place while maintaining

stabilization.

Care for shock.

Keep the patient at rest.

If possible, immobilize the affected area by splinting.

Objective: The examinee will demonstrate proficiency in stabilizing an impaled object.

Equipment: Simulated patient, 4x4 pads, trauma dressing, scissors, tape, bandaging material.

Cabrillo College EMT Training Program Avulsion (Complete) or Amputation



74


Control bleeding, if present.

Immobilize in position of comfort and dress wound.

In the case of avulsion assess neurovascular status of injured extremity.

Assess distal pulse, motor function and sensation (PMS).

Wrap avulsed tissue or amputated part in waterproof sterile dressing and place in container and

seal shut.

Apply ice or cold pack to container, assuring no direct contact with tissue.

Transport avulsed tissue or amputated part with patient.

Objective: The examinee will demonstrate knowledge of proper care for avulsion or amputation.

Equipment: Simulated patient, avulsed part, ice pack, plastic bag, dressings, bandages, tape.

Cabrillo College EMT Training Program Sucking Chest Wound



75


An open chest wound is a true emergency that requires rapid initial care in immediate

transport to a medical facility.

Maintain an open airway and provide basic life support if necessary.

Seal the open chest would as quickly as possible. If need be, use your gloved hand. Do not

delay sealing the wound to find an occlusive dressing.

Apply an occlusive dressing to seal the wound.

Assess for signs of tension pneumothorax. Remove dressing if signs of tension pneumothorax

develop.

Administer high flow O2.

Auscultate lung sounds.

Care for shock.

Place patient in position of comfort:

Upright – due to respiratory distress.

Shock position – if signs of shock appear.

On affected side, if possible. This allows the uninjured lung to expand without restriction.

Transport as soon as possible.

Objective: The examinee will demonstrate proficiency in assessing and treating a patient with a sucking chest wound.

Equipment: Simulated patient, occlusive dressing, tape, and stethoscope.

Cabrillo College EMT Training Program Pulse Oximetry



76


Connect the sensor lead to the monitor and clip the sensor probe to the patient’s fingertip.

Turn on the pulse oximeter.

Observe for SpO2 reading and heart rate. Make sure the heart rate displayed on the screen is the same as the patient’s palpated pulse rate.

Reassess every five minutes.

Objective: The examinee will state the reasons for using pulse oximetry and demonstrate proficiency in using a pulse oximeter.

Equipment: Pulse oximeter.

Cabrillo College EMT Training Program Cooling Measures - Infant



77


Unwrap and undress infant.

Transport in cool environment.

Sponge with tepid water (active cooling).

Stop cooling process as soon as infant begins to shiver.

Objective: The examinee will demonstrate proficiency in cooling an infant with a high fever.

Equipment: Simulated infant (fully dressed), tepid water, towel, and blanket.

Cabrillo College EMT Training Program Insertion of Esophageal Combitube (ETC Airway)


78


Preparation

Position yourself at patient’s head.

Assess the patient for proper age and size.

Suction any materials or fluids that might be obstructing the airway.

Assembly

Have second rescuer preoxygenate with a BVM supplied with 100% O2.

Connect the blue-tipped syringe (drawn up with at least 100ml of air) to the blue one-way

valve marked No. 1, then connect the white-tipped syringe (drawn up with at least 15ml of air)

to the white one-way valve tube marked No. 2.

Inflate both cuffs and check for leaks. Deflate cuffs.

Lubricate the distal end with a water-soluble lubricant.

Insertion

Keep the patient supine, with the head in a neutral, in-line position.

Perform a jaw-lift maneuver.

Holding the Combitube so that it curves in the same direction as the natural curvature of the

pharynx, insert the tip and advance it carefully along the tongue.

Insert the Combitube until the airway’s black rings meet the level of the patient’s teeth.

Using the large syringe, inflate the pharyngeal cuff with 100ml of air, then remove syringe.

Using the small syringe, inflate the distal cuff with 10 to 15ml of air, then remove syringe.

Do not force the

Combitube. If resistance

is met, pull back and

redirect the Combitube.


Cabrillo College EMT Training Program Insertion of Esophageal Combitube (ETC Airway)

Procedure continued from previous page.


79


Ventilate

Begin ventilation by attaching the BVM to the longer blue connecting tube marked No. 1.

Place a stethoscope over the patient’s stomach and auscultate for gurgling sounds. If no

sounds are heard, watch for chest rise and auscultate the chest for lung sounds bilaterally. If

the chest rises and bilateral breath sounds are heard, the Combitube is in the esophagus.

Continue ventilations.

If the chest does not rise and breath sounds are not heard, the Combitube is in the trachea. In

this case, remove the BVM from the No. 1 tube and attach it to the shorter clear connecting

tube marked No. 2, then ventilate the patient through it. Again, auscultate for breath sounds in

all lung fields, as well as the stomach. If there are no epigastric sounds and you see chest rise,

continue ventilations.

Continue ventilating the patient with a BVM supplied with 100% O2.

Reassess

Monitor Combitube’s efficacy and location to assure continued proper function.

Objective: The examinee will demonstrate proficiency in inserting a Combitube.

Equipment: Combitube kit, lube, stethoscope, BVM, airway manikin, assistant.

Cabrillo College EMT Training Program Insertion of Nasogastric Tube (NG Tube)



80


Preparation

Prepare all equipment.

Maintain adequate oxygenation of patient.

Measure tube length before insertion – nose to ear to xiphoid process.

Lubricate tube.

Insertion

Gently insert tube through one nostril. Motion should be downward along the nasal floor.

Insert tube to pre-determined measured location.

Confirm Placement

To confirm placement of tube in stomach, listen over epigastrium as 10-20cc of air is injected

through tube with syringe. A bubbling sound or rush of air should be heard by auscultation.

Apply suction to syringe. Gastric contents should be aspirated in the tube.

Apply Suction

Secure NG tube with tape.

Attach NG tube to suction device to decrease gastric distention.

Reassess

Monitor tube’s efficacy and location to assure continued proper function.

Objective: The examinee will demonstrate proficiency in insertion of a nasogastric tube.

Equipment: Nasogastric tube, manikin.

Name______________________________

82

Vital Signs Check-Off

You must complete 10 vital signs assessments (5 prior to Midterm tests). Enter your

observed readings and have the proctor (TA or instructor) sign and date the entry.

1. BP____________ Pulse___________________ Resp. ___________________

Proctor____________________________________ Date_________________

2. BP____________ Pulse___________________ Resp. ___________________

Proctor____________________________________ Date_________________

3. BP____________ Pulse___________________ Resp. ___________________

Proctor____________________________________ Date_________________

4. BP____________ Pulse___________________ Resp. ___________________

Proctor____________________________________ Date_________________

5. BP____________ Pulse___________________ Resp. ___________________

Proctor____________________________________ Date_________________

Midterm

6. BP____________ Pulse___________________ Resp. ___________________

Proctor____________________________________ Date_________________

7. BP____________ Pulse___________________ Resp. ___________________

Proctor____________________________________ Date_________________

8. BP____________ Pulse___________________ Resp. ___________________

Proctor____________________________________ Date_________________

9. BP____________ Pulse___________________ Resp. ___________________

Proctor____________________________________ Date_________________

10. BP____________ Pulse___________________ Resp. ___________________

Proctor____________________________________ Date_________________

Name______________________________

83

CPR Check-Off

You must complete three Adult and Child One-Rescuer CPR skill checks prior to the final exam.

Have the proctor (TA or instructor) sign and date the entry.

1. Adult and Child One-Rescuer CPR skill correctly demonstrated to:

Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________

Name______________________________

84

Spine Board Strapping Check-Off

You must complete five Spine Board Strapping skill checks prior to the final exam. Have the

proctor (TA or instructor) sign and date the entry.

1. Combat or Spider Strapping skill correctly demonstrated to:

Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________

Mnemonics

A – Alert

V – responsive to Verbal stimuli

P – responsive to Painful stimuli

U – Unresponsive

A – Alcohol

E – Epilepsy

I – Infection

O – Overdose

U – Underdose/Uremia

T – Trauma

I – Insulin

P – Psych/Pregnancy

S – Seizure/Stroke

P – Provocation

A – Associated chest pain

S – Sputum/Severity/Sleep position

T – Temperature/Time

E – Events/Exercise/Exertion

P – Pupils

E – Equal

R – Reactive

L – to Light

P – Pupils

E – Equal

R – Round

R – Reactive

L – to Light

A – Appearance

P – Pulse

G – Grimace

A – Activity

R – Respiration

O – Onset

P – Provokes

Q – Quality

R – Region/Radiation

S – Severity

T – Time

S – Signs/Symptoms

A – Allergies

M – Medications

P – Pertinent history

L – Last oral intake

E – Events

S – Salivation

L – Lacrimation

U – Urination

D – Defecation

G – GI cramping

E – Emeses

M – Miosis

D – Deformities

C – Contusions

A – Abrasions

P – Punctures/Penetrations

B – Burns

T – Tenderness

L – Lacerations

S – Swelling

S – Simple

T – Triage

A – And

R – Rapid

T – Treatment

R – Respirations

P – Perfusion

M – Mentation

C – Chief Complaint

H – History

A – Assessment of Patient

R – (Medications)

T – Treatment

F – Face

A – Arm

S – Speech

T - Time

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