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Equipment Used in Home Health Setting

October 2013 CECondell Medical CenterEMS SystemSite Code: 107200E-1213

Prepared by: Sharon Hopkins, RN, BSN, EMT-P

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ObjectivesUpon successful completion of this module, the

EMS provider will be able to:

Discuss population served by Home Health Care or in need of specialized equipment.

Discuss the psychosocial concerns patients experience when receiving home health care.

Describe various pieces of equipment used in the home care population

Describe EMS care related to the piece of equipment while transporting the patient

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Objectives

Actively participate in case scenario discussion.

Actively participate in review of equipment typically present in the home setting of chronically ill patients.

Successfully complete the post quiz with a score of 80% or better.

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Population Served by Home Health Care A patient being discharged from an acute

care setting To home To skilled nursing facility

Nursing home Assisted living Rehabilitative services

Patient care continuing with some type of device or specialized care required that promotes health and well-being

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Psychosocial Aspects of Home Health Care Patients Patient and caregiver(s) have received

education on the medical condition and equipment Use them as a resource – they may know better

Some patients are sick and tired of being sick and tired Patient and caregiver may not be at their best and

can be frustrated, angry, short tempered We are caring for people who are at their lowest Treat the patient and caregiver as you would want your

family member treated

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EMS Interaction with Patients Receiving Home Health Care You may know more about medicine in

general but the patient and family/care giver know more about the patient’s medical condition and equipment than you do (usually)

Use the resources at hand when dealing with additional equipment that is foreign to you

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Typical Equipment in the Home Health Environment

Oxygen Trach tubes Ventilators Central lines PICC lines NG tubes PEG tubes

Dialysis Foley catheters Suprapubic tubes Nephrostomy tubes Ostomies

Colostomy Ileostomy

Wound vacs

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Home Oxygen

Patient on home oxygen would be transferred to EMS O2 source

When turning off any O2 tank, bleed down the valve Prevents inadvertent leakage of oxygen through

an open system Turn valve off (counter clockwise) Turn up flow rate When needle bleeds down to “0”, turn flow rate to “0”

Prevents damage to O ring

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Oxygen Concentrator Device resembles a dehumidifier and

concentrates oxygen from ambient gas removing Nitrogen to deliver an oxygen rich supply (approx 97-98%)

Typically can deliver 1 – 5 lpm of O2

This device allows the patient unrestricted mobility – can run on batteries Would be useful in a power outage

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Tracheostomy Surgical opening in the anterior wall of the trachea

to facilitate breathing Air bypasses the pharynx and larynx Generally, patients are unable to speak

May be taught/trained depending on trach tube size, design, and condition of larynx

Can be placed when there is obstruction present Used to obtain an airway due to injuries

or surgery to the head and neck area Used to prevent the risk of aspiration

in patient with poor cough/gag reflex

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Tracheostomy

Introduction of obturator Similar to placing a QuickTrach

Tube being placed into position in trachea

Trach tube in place Inner cannula separated

from outer cannula

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Tracheostomy Potential complications

Loss of tube patency (i.e.: secretions, mucous plugs)

Displacement of tube Assessment

Signs / symptoms respiratory distress? Decreasing oxygen saturation? Tachycardia/bradycardia? Hypotension? Decreasing level of consciousness?

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Tracheostomy Typical equipment Outer cannula inserted

into trachea Cuff at distal tip protects

airway against aspiration Cuff allows positive pressure ventilation Some tubes are uncuffed for some populations

Inner cannula inserted through the outer cannula

Device secured in place with trach ties around the neck

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Tracheostomy - Trach Tubes Equipment may consist of a fenestrated (hole(s)

in tube) or non-fenestrated tube Fenestrated tube facilitates ease of producing a

voice; used during the weaning process Trach can also be “plugged” during weaning

Trach tubes have an inner cannula in place Inner cannula removed

every day for cleaning Spares are generally

kept with the patient

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Tracheostomy EMS care

Assess the patient’s airway status Be prepared to assist with ventilations

BVM connects to universal 15mm proximal end of trach tube Some long term trachs have shorter profiles that don’t connect

to BVM’s Be prepared to suction patient

Limit time to 10 seconds per attempt If possible, allow patient to

reoxygenate between suctioning attempts

Enrich environment with blow-by O2 Hold O2 tubing next to trach

opening

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Ventilators

Used for patients unable to ventilate / breath on their own

Patient would have a tracheostomy (“trach”) tube if home on a vent

Ventilators can be set to assist with the patient's own breaths or totally control the patient’s breathing

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Ventilators If patient must be transported, continue to

keep patient ventilated If ventilator is small enough and can be

transported with patient, do so If patient cannot be transported with ventilator,

would need to ventilate patient via BVM Pay particular attention to maintain the patient ventilation

rate as set by ventilator In absence of knowledge of pre-set rate, follow AHA

ventilation guidelines for advanced airway device Neonate – 1 breath every second Infant and child – 1 breath every 6 seconds Adult – 1 breath every 6 seconds

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Central Lines These lines are placed in a large vein

Intended for long term use (i.e.: months or years) Generally placed under general anesthesia by a

surgeon Prevents repeated needle sticks through the skin

into a vein Used to administer medication and fluids

directly into the bloodstream Blood products can be administered Blood for lab work can be withdrawn

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Central Lines Hickman or

Broviac

PICC line

Port-a cath

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Central Lines – Hickman or Broviac Long silicone catheter inserted into a large vein (i.e.: superior vena cava) directly into the heart

May be one or two separate lumen catheters Cuff just under skin helps to anchor catheter

in place Cuff also blocks bacteria from migrating into

bloodstream Initially, visible sutures secure catheter in

place until cuff is adhered to tissue Meticulous care necessary at exit site

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Central Lines – Port-a cath Port totally implanted under the skin providing

access to central venous circulation Port has a reservoir with injectable septum

Catheter attached to reservoir is threaded into large vein leading to heart

Port placed under general anesthesia by surgeon Most placed under collarbone

May be placed under arm on chest wall or in abdominal area

Port requires no special care for skin careDevice implanted below the skin surface

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Central Lines - PICC

Peripherally inserted central line May have single or multiple lumens Inserted into a peripheral vein, generally in the

upper arm Catheter advanced until tip terminates in a large vein in

the chest near the heart Point of entry is from the periphery Inserted under the benefit of ultrasound by

specially trained staff Can remain in place for a longer duration than

other central or peripheral access devices

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Central Lines – PICC cont’d

Used for Prolonged antibiotic therapy Medication administration Prolonged nutrition Chemotherapy Blood draws for lab work Home or sub-acute treatment at home for long

periods Lower complication rates over alternative

central lines

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PICC Lines

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Central Lines and EMS Care EMS must protect site from potential infection

Dressings should remain in place Wet or loose dressings increase risk for infection

Avoid pulling/tugging on lines NEVER access site

This is a central line Some sites need specialized equipment A meticulous protocol is followed to access

site Appropriate PPE equipment is worn when

dressing changes are performed

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Central Lines and EMS Care

Avoid obtaining B/P in arm cannulated with PICC

Do not use scissors around the catheter site to avoid inadvertently cutting the catheter

Avoid getting the dressing wet Never flush the catheter for the patient

Catheters are flushed daily and must follow a set protocol

Solutions may include saline and/or heparin

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Nasogastric Tubes This is a tube inserted

though the nose or mouth and into the stomach

Used to allow drainage of the stomach or to provide nutrition when the patient is unable to take oral food and liquids themselves

J-tube (Dobhoff tube) is a weighted tube that passes through the stomach, past the pyloric sphincter, and ends in the jejunum

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Nasogastric (NG) Tubes Typical patient

Any patient unable to swallow due to change in anatomical structures or for disease

EMS care If tube is clamped off, leave it as is If tube feeding in process and cannot be

disconnected, transport with patient in same position (usually upright) and tube feeding bag at same height

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Nasogastric (NG) Tubes – EMS Care Do not put anything into tube

Tube placement must ALWAYS be confirmed prior to administering anything into it Tube may have slipped from esophagus into the trachea All medications must be well dissolved and in liquid form

If tubing is misclamped, may start leaking from ports Cover end of tubing with gauze Inform nurse upon arrival at hospital

If tube is not properly flushed when disconnected, may become plugged Inform ED staff if NG tube not flushed when disconnected

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PEG Tube

Percutaneous endoscopic gastrostomy A soft, plastic tube inserted into

stomach through the abdominal wall May be permanent or temporary

Typical patient Patient unable to eat or drink and this allows for

feedings May be fed via a syringe, gravity drip bag or

feeding pump

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PEG Tube cont’d Precautions

Skin care is required daily around insertion site Hub of tube (tube opening) needs to be cleaned

daily Tube must be flushed before and after each use

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PEG Tube cont’d

EMS care If PEG tube is clamped, leave clamp in place Do not pull on tube Bumper around end of tube should be flush and

snug to the skin If tube feeding is in process, can maintain

equipment at same height and transport patient If tube comes out, patient needs to have tube

replaced at hospital right away Stoma can start to close within 2 hours

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Dialysis A life saving procedure to substitute for

normal duties of the kidneys Filtering of waste products from blood Regulation of the body’s fluid balance

2 types used Hemodialysis

Mature, healthy fistula site can be used for many years Peritoneal dialysis

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Dialysis

Peritoneal

Hemodialysis

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Dialysis cont’d

Typical patient Patient in kidney failure

Can be an acute event or a chronic condition Condition often monitored by measuring the blood

levels of creatinine and blood urea nitrogen (BUN) Increasing levels indicate the decreasing ability of

kidneys to cleanse the body of waste products

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Hemodialysis Hemodialysis

Use of a special filter to remove excess waste products and water from the body

Blood passes from the patient's body through a filter in the dialysis machine

A needle is placed into the graft or fistula Blood is delivered to the dialysis machine

Blood is filtered Blood is returned to

the patient

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Hemodialysis

AV Fistula Connection of a vein and an artery in your arm

Allows blood from body to be pulled out into dialysis machine and then put back into the body

The physician assesses for the best site (i.e.: a strong vein and artery) The fistula will most likely be needed for a long time

Graft A plastic tube placed between an artery and a

vein in the arm or leg

Try to

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Hemodialysis cont’d

Patients generally in treatment 3 times per week on alternating days

Treatment lasts from 2½ to 41/2 hours

A working fistula is a life insurance policy

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Peritoneal Dialysis

Patient’s own body tissues inside abdominal cavity act as the filter

Plastic tube placed though abdominal wall into abdominal cavity

Special fluid flushed into abdominal cavity and washes around the intestines Intestinal wall acts as filter between fluid and

blood stream Fluid drained out back into a collection bag

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Peritoneal Dialysis cont’d Patient has a major role in maintaining a

clean surface on the abdominal wall to prevent infection

Each procedure takes 30 minutes to accomplish

Procedure repeated 4 – 5 times a day 7 days a week

As an alternative, patient may use a special machine every night 5 – 6 bags of dialysis fluid used in the exchange

while the patient sleeps

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Dialysis

Care by EMS NEVER place tourniquets or B/P cuffs on

extremity with graft or fistula NEVER start an IV in the extremity with a graft or

fistula If peritoneal dialysis is in process, maintain bag at

same height If draining into patient, will be elevated like an IV bag If draining from patient, will be lower than the patient's

waist

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Foley Catheter

Closed drainage system device to drain the urinary bladder Catheter is placed through the urethra into the

bladder A water filled balloon holds the catheter in place External tubing then secured to the patient

Typical patient Debilitated patient Comfort to keep patient clean and dry and free

from skin breakdown due to exposure to urine

Non-functioning urinary system

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Foley Catheters cont’d Indications

Need to drain the bladder of urine Catheter allows for continuous drainage of urine Catheter held in place by water filled balloon at

end of tube inserted into bladder via the urethra Usually 10 ml of

saline/water in balloon

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Urine Drainage Bags

Bedside drainage bag Usually worn when at home

Typically worn at night Caution with length of tubing that it does not get

“caught” on anything Leg bag

Typically worn when out of the house

Usually secured with straps to the leg

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Foley Catheter cont’d

Care by EMS NEVER pull on foley catheter ALWAYS keep drainage bag below the level of

the patient’s waist Prevents back flow of urine into bladder to reduce the

risk of infection Do NOT lay drainage bag on floor Catheter often secured to the patient’s thigh or

abdomen without tension on the tubing

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Suprapubic Catheters

Surgically implanted catheter through the abdominal wall and into the urinary bladder

Held in place with water filled balloon

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Suprapubic Catheters

Typical patient Alternative route used when a catheter cannot be

passed through the urethra due to obstruction Can be used for patients with a neurogenic

bladder Bladder does not contract to empty urine Often found in patients with spinal cord injury

Indications Used for long term use to drain the urinary

bladder

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Suprapubic Tubes cont’d EMS care

NEVER pull on foley catheter ALWAYS keep drainage bag below the level of

the patient’s waist Prevents back flow of urine into bladder to reduce the

risk of infection Do NOT lay drainage bag on floor

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Nephrostomy Tubes

Urinary drainage device surgically implanted into the renal pelvis of the kidney

Consists of a nephrostomy tube and a collection bag

Typical patient Used in patients with some form of kidney disease Allows for drainage of urine from the kidney when

normal urinary flow is impeded or obstructed Often used for urinary obstruction such as a renal stone

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Nephrostomy Tubes Indications

Permits drainage of urine from the kidneys

Catheter tube may be sutured in place or secured with velcro-like device to a wafer dressing similar to ostomies

Precaution Increased risk of infection due to direct pathway

to the kidney

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Nephrostomy Tubes

EMS care NEVER pull on foley catheter

Very important to prevent accidently pulling tube out Taping often used to minimize tension and to prevent

dislodging ALWAYS keep drainage bag below the level of

the patient’s waist Prevents back flow of urine into bladder to reduce

the risk of infection Do NOT lay drainage bag on floor

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Ostomies Ostomies are artificially created openings to the

abdominal wall to allow the organ to continue to function and excrete waste products Colostomy (large intestine), ileostomy (small intestine),

urostomy (urinary system) May be temporary or permanent Most patients wear an appliance over the stoma to

collect the waste product Stomas are typically red, moist and protruding in

appearance No nerve endings in a stoma Patients usually have no control over when and where stool

or urine is passed Consistency of drainage dependent on location of ostomy

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Ostomies

Typical patient Patient with disease in the organ that needed

surgical resection of a part of that organ Indications

To relieve the body of stool or urine, depending on nature of ostomy

Usually placed due to obstruction or disease in which part of the organ was removed

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Review – Anatomy of the Colon The colon is identified in sections

See previous slide The large intestine includes the cecum,

colon, rectum and anal canal A function of the large colon is to absorb

water, sodium and some fat soluble vitamins and recycle back to the body as waste products are propelled through the 15 feet

Stool becomes more solid as it moves through the descending colon

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Ostomy Care & EMS

EMS care Do not put pressure on the

collection bag May cause the bag to rupture and

spill contents Transport the patient with the

bag intact If a caregiver wants to empty the bag prior to EMS

departure from the scene, they may do so if the delay is acceptable to EMS EMS should refrain from attempting to empty ostomy

pouches

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Ostomy Care & EMS cont’d

Extra supplies should be transported to the hospital with the patient, if possible The patient may need a change of supplies and

the receiving hospital may not have their skin barrier product or bag in compatible sizes or material

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Wound Vac Therapy A negative pressure wound therapy system

designed to promote wound healing though granulation tissue formation

With use of a special foam dressing in the wound, mechanical forces are applied to the wound to create an environment that promotes wound healing

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Wound Vac cont’d

Wound edges are drawn together Complete wound bed contraction is induced Negative pressure is evenly distributed Exudate and infectious material is removed At the cellular level, edema is reduced and

perfusion is promoted Tissue healing is promoted Dressing changes occur several times per

week

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Wound Vac System During dressing changes, foam cut to size Foam placed in wound Wound site covered with suction device Transparent dressing placed over site

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Wound Vac cont’d Typical patient

Patient with an open wound that will be healing from the inside out

Black foam dressing is visible through a clear dressing applied over wound

Device is run by an electric vacuum pump Leave dressing intact

and unplug unit and transport unit with patient Unit will run on batteries

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Wound Vac System

EMS implications Suction will continue to be applied via battery

power on the device Suction needs to be maintained Foam cannot be left in wound for long periods without

suction Trained care giver would change dressing if suction off for

longer than an hour or two Foam dressing removed and wet-to-dry dressings placed

Avoid pulling on suction tubing Inform ED staff that patient has a wound vac

system

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Excited Delirium

Not a diagnosis but a state A collection of an acute onset of symptoms

from varied and severe underlying processes Characterized by

Extreme agitation Hyperthermia Hostility Exceptional strength and endurance without

apparent fatigue

Morrison and Sadler 2001

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Excited Delirium cont’d

Recognized for past 10 years Typically associated with use of drugs that

alter the dopamine processing in the brain At risk persons

96-99% males Generally 31 – 44 years old Usually involves a struggle Death follows bizarre behavior and use of illegal

drugs

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Excited Delirium cont’d Can mimic

Head injury Hyperthermia Meningitis Autism

Don’t make assumptions Use critical thinking skills to think of all

possibilities Avoid tunnel vision in forming general impression

One study identified fatal outcomes as rare BUT…when they do occur, litigation can be costly

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Excited Delirium cont’d 4 phases

Profuse sweating Delirium with agitation Respiratory arrest Cardiac arrest

Officers struggling with the patient are often unaware that the patient has stopped struggling & screaming and has arrested Post mortem autopsies often report negative

toxicology reports Drug use does not have to be concurrent with behavior

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Excited Delirium – Behavioral Cues Intense paranoia Extreme agitation Disoriented about time, place, purpose Unable to be talked down Screaming Pressured, loud, incoherent speech Grunting, guttural sounds Talking to invisible people Irrational speech

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Excited Delirium – Behavioral Cues Violent behavior Bizarre behavior Aggression toward objects (glass, shiny

objects) Runs into traffic Naked Reduced sensation to pain

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Excited Delirium – Behavioral Cues Super human strength Seemingly unlimited endurance Resists violently

Capture Control Restraint

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Excited Delirium – Physical Characteristics Dilated pupils Lid lift (eyes wide open) Profuse sweating Hyperthermia (not always present) High core body temperature (1030 – 1100) Skin discoloration Large belly Foaming at mouth Uncontrollable shaking Respiratory distress

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Excited Delirium - Cascade of Events Hyperthermia Hypoventilation Rhabdomyolysis

Breakdown of skeletal muscle tissue (i.e.: during struggle)

Myoglobin (muscle protein) leaks into urine Can plug the filtering tubes of the kidneys and cause

kidney failure Muscle injury can leak potassium into the blood

causing hyperkalemia (cardiac irritant!!!)

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Cascade of Events cont’d

Acidosis Excess build of waste products not being excreted in form

of CO2 when hypoventilation occurs

Death may not be immediate

Rapid and aggressive medical intervention (i.e.: sedation) necessary even in presence of only a few behavioral cues

Important for accurate body temperature to be documented as soon as possible (field or ED)

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Helpful to dialogue ahead of time with local PD regarding respective action with patient

Need to have a high index of suspicion Patient needs sedation as soon as possible EMS will need to stage until scene is safe PD will need to physically capture, control,

and restrain patient Then EMS can make patient contact to

provide sedation

Excited Delirium – EMS Response

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Excited Delirium – EMS Response EMS intervention VERY tough!!!

Prior to administration of medications, you are asked to perform some form of patient assessment and obtain vital signs

This is not the kind of patient vital signs will be easy to obtain

Do the best you can A life saver to the patient with excited delirium is

sedation Need to control patient stress and exertions

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Region X SOP – Behavioral Emergencies Drug Administration For SEVERE anxiety or agitation

Versed 2mg IN May repeat Versed 2mg IN every 2 minutes titrated to

desired effect Maximum total dose 10 mg

If additional sedation required Valium 5 mg IVP over 2 minutes

May repeat as needed Maximum total dose of 10mg

Valium 10 mg IM may be given as alternative to IVP

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Case Scenario #1

EMS is called to the scene for a 72 year-old patient with a dislodged foley catheter

Upon arrival the patient points to the foley catheter, with balloon intact

How would you care for this patient???

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Case Scenario #1 – Discussion Questions Would you reinsert the foley catheter?

No This must be done under sterile technique and by

trained persons Does this patient require special care while

transporting them? No If there is bleeding present at the urethral

opening, cover with a dressing

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Case Scenario #1

If your patient had an indwelling catheter to drain urine, how should you handle the equipment during transport?

Keep the drainage bag below the level of the patient's waist Do NOT want urine to flow back

into the bladder

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Case Scenario #2

EMS is called to the scene for a patient with a plugged trach tube

What care are you anticipating the patient may need to relieve the obstruction???

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Case Scenario #2 To relieve a plugged trach tube

Consider suction Advance catheter until patient starts to cough

Suctioning should be non-painful Usually triggers coughing which also helps loosen

secretions Limit suction time to max of 10 seconds

May need to ventilate the patient via BVM Neonate - 1 breath per second Infant and child – 1 breath every 6 seconds Adult – 1 breath every 6 seconds

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Case Scenario #3 EMS is called to the scene of a patient with a

wound vac Power has been lost to the house

Is it important for this patient to be connected to a power source or can they wait indefinitely for power to resume??? Wound vac must be connected to a power source

to run; patient can tolerate 1-2 hours off suction Wound vac will run on batteries

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Case Scenario #3

What to do with a wound vac when power is lost

If negative pressure is not maintained in the wound, the black foam needs to be removed

The patient would receive a wet to dry dressing in the absence of constant suction being applied This dressing would be applied by a trained person after

removal of the black foam EMS should transport the patient

Stress to ED staff that patient has a wound vac in place Staff can alert in-house resources for assistance if

needed

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Case Scenario #4

EMS is called to the scene for a patient bleeding from their colostomy site Colostomy is established

Means not new for the patient

The patient history includes being on xarelto

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Case Scenario #4 – What’s the rhythm?

Atrial fibrillation Irregularly irregular rhythm No discernible P waves Distinctive palpable pulse (varied levels of

strength)

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Case Scenario #4

Why would patient be bleeding??? Irritation at site Active GI bleed Effects of xarelto

What is xarelto??? Blood thinner used to minimize risk of stroke in

patient with atrial fibrillation Additional blood thinners: coumadin (warfarin),

pradaxa (dabigatran), eliquis (apixaban)

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Case Scenario #4

What should EMS do???

Apply pressure to site, if required, based on amount of bleeding

Do not attempt to change equipment for patient

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Case Scenario #4 Due to patient history of atrial fibrillation (afib), what

are implications to EMS?

Increased risk for stroke due to blood clot formation Increased risk of bleeding due to use of blood

thinners

Report whether a fib is potentially of new onset or long standing

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Case Scenario #5 You have responded to the scene for a naked

patient yelling and screaming and acting bizarre

EMS has staged while PD is on the scene Once able, what medication is used for

patient sedation? Versed 2 mg IN every 2 minutes Can titrate to 10 mg If additional sedation required, Valium 5 mg IVP

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Case Scenario #5

What are the benefits of administering a medication via the IN route? Avoids risk with a needle exposure

How is a medication administered via the IN route? Plunger needs to be pushed fast enough to create

a mist Dose may be divided per nares to increase

surface absorption space Max volume is 1 ml per nares

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Case Scenario #6

EMS responds to a call for a patient not feeling well

Upon arrival there is evidence of specialized equipment in use

The caregiver “just ran an errand” The patient is not sure what their equipment

is or what it is used for

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Case Scenario #6 – Trivia Challenge If you saw this piece of equipment, what do you think it is? Colostomy on ascending colon

What is it used for? Port for body excretions

Are there any special precautions during patient transport? If no collection bag, cover with

trauma dressings and chux Anticipate stool to be more liquid

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Case Scenario #6 – Trivia Challenge

If you saw this piece of equipment, what do you think it is? Nephrostomy tube

What is it used for? Drains urine from the kidney

Are there any special precautions during patient transport? Avoid pulling on tube If drain bag connected, keep lower than pt waist

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Case Scenario #6 – Trivia Challenge

If you saw this arm, what would you think? A fistula or shunt is present

What is it used for? For access for hemodialysis

Are there any special precautions during patient transport? No B/P or IV sticks to that extremity

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Case Scenario #6 – Trivia Challenge

If you saw this piece of equipment, what do you think it is? A PICC line

What is it used for? For access to central circulation

Are there any special precautions during patient transport? Do not pull on the tubing Do not increase any risk of infection to the line Do not access lines!!!

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Case Scenario #6 – Trivia Challenge What’s this rhythm?

Any EMS implications? Is patient stable or unstable?

What is the level of consciousness & B/P???

Sinus bradycardia with first degree heart block

First degree is a CONDITION of a rhythm; not a true rhythm by itself!!!

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Case Scenario #6 – Trivia Challenge What’s this rhythm?

Any EMS implications? Can be a normal rhythm in some people Patients rarely symptomatic due to this rhythm

If patient symptomatic, keep looking for another cause

Second degree Type I - Wenckebach

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Case Scenario #6 – Trivia Challenge What 4 rhythms found in the adult population could cause an irregular pulse? Atrial fibrillation – always irregular

Check for meds including digoxin and blood thinners Atrial flutter – may or may not be irregular Premature beats – PVC, PAC, PJC

Think PVC’s if cardiac or COPD patient Think PAC’s if stimulants in younger person

First degree Type I Wenckebach PR intervals get longer, longer, longer until there is a

dropped QRS

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Home Health Equipment and EMS Basically…

If it’s a tube protruding out – don’t pull on it If it’s in a bag, don’t put pressure on the bag

Don’t want the bag to rupture and spill its contents If you can transport the patient to the hospital with

all connections intact, do so If there is a caregiver present who can assist, use

them They are usually very familiar with the equipment and

processes for handling it

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Bibliography

Bledsoe, B., Porter, R., Cherry, R. Paramedic Care Principles & Practices, 4th edition. Brady. 2013.

Limmer, D., O’Keefe, M. Emergency Care 12th Edition. Brady. 2012.

Region X SOP’s; IDPH Approved January 6, 2012. Lt. Michael Paulus, Southwest District Commander;

Champaign, Illinois www.exciteddelirium.org http://www.med.uottawa.ca/procedures/ucath/ https://patienteducation.osumc.edu/documents/

fenestr.pdf

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Bibliography http://www.ucdenver.edu/academics/colleges/medic

alschool/departments/medicine/hcpr/cauti/documents/Sample%20Policy%20and%20Procedures.pdf

http://www.phoenixuoaa.org/protected/your-complete-recovery-from-ostomy-surgery

http://www.medicinenet.com/dialysis/article.htm http://www.nhsggc.org.uk/content/default.asp

?page=s1214_12_2 http://www.alsfrombothsides.org/trachcare.ht

ml