EMS Equipment Review

MARCH 2015 CECONDELL MEDICAL CENTER EMS SYSTEM CEIDPH SITE CODE #107200E-1215

PREPARED BY: SHARON HOPKINS, RN, BSN, EMT-P

1

Objectives

Upon successful completion of this module, the EMS provider will be able to:List indications for use of a variety of EMS equipment used in the field.Manage a group of peers in setting up and applying a variety of equipment used in the field.Evaluate the effectiveness of application of a variety of EMS equipment in a practical setting.

2

Objectives cont’d

Actively participate in review of selected Region X SOP’s as related to the topics presented.

Actively participate in review of the process of transmission of 12 lead EKG’s using department specific equipment.

Actively participate in reviewing the operation of your department monitor/defibrillator, pacing capacity, synchronized cardioversion

and defibrillation at the paramedic level.

3

Objectives cont’d

Actively participate in HARE/Saeger traction application.

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

4

Equipment and Patient Interventions

There comes responsibility when using equipment in the delivery of patient care. You need to: recognize what the problem is to know what to do be able to distinguish what the appropriate

intervention(s) is/are understand how to properly apply and use the equipment

chosen recognize when the intervention is working as well as not

accomplishing the goal know what documentation must be done with each piece

of equipment used in patient care be knowledgeable regarding the cleaning and returning

to service for each piece of equipment

5

Capnography Background

A continuous, non-invasive monitoring tool Measures level of CO2 at end of exhalation

Quantitative results provides a number

Assesses respiratory status thru-out respiratory cycle Provides current, at the moment, breath-to-breath

information on patient status Results measured as mmHg of CO2

Normal 35 – 45 mmHg

6

Capnography Information

Numeric value provides end tidal (end of breath) CO2 level

Waveform is a picture representation of the CO2 value exhaled with each breath

Airway status reflected in: ETCO2 value (mmHg)

Waveform picture Respiratory rate

7

Definitions

Ventilation Process of breathing; eliminating CO2 from body

Respiration Exchange of gasses at alveoli level

Oxygenation Getting O2 to tissues; measured by pulse oximetry

Diffusion Process by which gas moves between alveoli and pulmonary capillaries

(gases move from area of high concentration to areas of low concentrations)

8

Capnography Usefulness

Provides information on how effectively the body is: Producing CO2 (metabolism)

Transporting CO2 (perfusion)

Exhaling CO2 (ventilations)

Goal – attain/maintain CO2 levels 35 – 45 mmHg

9

Capnography Usefulness cont’d

Confirms and monitors advanced airway placement Indicates effectiveness of chest compressions

Blood must circulate through lungs to off-load CO2 for it to be exhaled

Levels expected to minimally be >10mmHg during CPR

Indicates return of spontaneous circulation (ROSC) Sudden, sustained rise in levels toward 35-45 mmHg

Allows early interventions to be started

10

Capnography Usefulness cont’d

Monitor asthma & COPD conditions and response to bronchodilator therapy

Detect increased respiratory depression and hypoventilationTiring accessory musclesNeuromuscular disease effect on respiratory centerChange in level of consciousness – alcohol/drug overdose,

head trauma, sedation/analgesiaSeizure activity &/or post ictal period

11

Capnography Waveform

A-B – respiratory baseline B-C expiratory upslope C-D expiratory plateau D – end of exhalation

point of measurement D-E – inspiratory downslope

12

Capnography Waveforms

HypoventilationCO2 retained so

values

HyperventilationCO2 eliminated

so values

13

Capnography Waveforms

Asthma attack or COPDDifficulty exhaling evidenced by slow, gradual

upslope

14

Capnography Waveforms

Apnea or loss of advanced airway

- flat line

15

ETCO2 Detector

End tidal (end of breath) CO2 detector

Qualitative device Indicates presence/absence of detectable CO2 exhaled via pH

sensitive paperDoes not provide specific measurement of numeric value

Color scale estimates CO2 levelAble to change as detected levels change

May take up to 6 breaths to wash enough CO2 out for proper measurement

16

ETCO2 cont’d

Gastric content or acidic drug contact on pH paper can affect accuracy of values detected

When perfusion decreased (shock, arrest) ETCO2 reflects change in pulmonary blood flow and CO2 level

Does not reflect ventilation status

17

Altered CO2 Levels

CO2 level

Shock, cardiac arrest, pulmonary embolism, bronchospasm, complete airway obstruction

CO2 level

Hypoventilation, respiratory depression, hyperthermia

18

CO2 Influence on Circulation

CO2 in blood (hypoventilation)Cerebral vasodilation increase in intracranial

pressure (ICP) due to increased blood flow to the brain

CO2 in blood (hyperventilation)Cerebral vasoconstriction decrease in fresh blood

flow to brain; decrease in levels of adequate oxygen and glucose negatively affect function of brain

19

ETCO2 Result Interpretation

Yellow – yes, CO2 is being detected in exhaled breath

Tan – poor perfusion or ventilation statusFirst evaluate placement of airway deviceContinue to trouble shoot

Blue or purple – no CO2 being detected

First evaluate placement of airway deviceContinue to trouble shoot

20

Trouble Shooting Advanced Airway Placement – “DOPE”

D – displacement of tube (i.e.: into esophagus)Chest rise and fall?Gastric sounds? Bilateral breath sounds?

O – obstruction P – pneumothorax E – equipment failure

Faulty cuff

21

Esophageal Detector Device - EDD

A modified bulb syringe Simple means of evaluating for missed endotracheal

intubation Squeeze bulb, attach to end of endotracheal tube Bulb re-expands = tube in trachea Bulb does not re-expand or does so slowly – collapsing

sides of esophagus onto tube preventing air from filling EDD – consider esophageal placement

22

EDD cont’d Need to interrupt ventilations to use device Evaluate results of technique used with results of all

other steps of confirmation – could be extenuating reason why you get false negatives

23

Defibrillators

Electrical capacitor that stores energy Biphasic defibrillators provide waveforms that

use less DC energy than monophasic machinesEnergy flows in one direction and then reverses

Therefore, possible decrease in tissue damage Survival rates increase if early CPR provided

with prompt defibrillation attempt as soon as possible after collapse

24

Defibrillation

Early defibrillation critical to survival from sudden cardiac arrestMost frequent initial rhythm in arrest is VFTreatment for VF is defib (defibrillation)Probability of successful defibrillation diminishes

over timeVF deteriorates to asystole over time

Check with your vendor to know your biphasic device’s recommended energy settings

25

Ventricular Fibrillation as Presenting Rhythm

Best chance of survival in public Early activation of EMS CPR initiated very soon after collapse Early application of AED or other defibrillation attempt

Current passes though fibrillating heart to depolarize heart cells to allow them to uniformly repolarizeAllows dominant pacemaker (SA node) to take over

electrical controlGoal – resume organized electrical activity

26

Influences on Success of Defibrillation

Time from onset of VF – shorter time survival Condition of myocardium

Less success in presence of hypoxia, acidosis, hypothermia, electrolyte imbalance, drug toxicity

Pad sizeLarger pads felt to be more effective and cause

less myocardial damage; should not overlapIdeal size for adults10-13 cm (4 -5 inches)Ideal size for peds 4.5 cm (roughly 3 inches)

27

Influences cont’d

Pad / skin interfaceNeed to the resistance

Greater the resistance the less energy delivered to the heart and the greater the heat production at the skin surface

Pad contactMax contact with skin; no air bubbles breaking

contact; no pads touching or overlapping Avoiding placement of pads over bone

Bone is poor conductor of electricity

28

Pad PlacementOperator Choice

Anterior /posterior1 pad over apex of heart, under left

breast1 pad under left scapula in line with

anterior pad Anterior/anterior (apex)

Anterior pad on right upper sternum just below clavicle

Apex pad below left nipple in anterior axillary line over apex of heart

29

Pad Placement cont’d

DO NOT place padsOver sternum – bone poor conductor of

electricityOver pacemaker or AICD – deflects energy;

could damage the implanted devicePlace at least one inch away from device

Over topical medication patches – deflects energy

30

Defibrillation

IndicationsVF, pulseless VT

ContraindicationsFailure to demonstrate one of the above rhythmsAsystole – defibrillation places a patient into

asystole for the dominant pacemaker to take overPEA – electrical activity not a problem; needs

mechanical response fixed

31

Defibrillation

EquipmentMonitor/defibrillatorDefibrillating pads

Example: PadProDefibrillation/pacing/cardioversion/monitoring

electrodes

Most come with conductive gel already applied in center of pad

32

Defibrillation Safety

CPR is performed just until the defibrillator is ready Confirm O2 not blowing across patient’s chest wall –

hold away from the patient when not using the BVM Physically look all around (“nose to toes”) Clearly yell out “all clear” Deliver energy

Immediately resume CPR

33

Return of Spontaneous Circulation ROSC After 2 minutes of resumed CPR, evaluate the

rhythm If an organized rhythm is viewed on the

monitor, THEN check for a pulse If no pulse, rhythm is PEAResume CPR

Adult 1 and 2 man CPR 30:2Infant and child 1 man CPR 30:2Infant and child 2 man CPR 15:2

34

Indications to Activate Cooling Protocol Post ROSC

Presumed cardiac arrestNOT indicated for respiratory or traumatic

arrest Remains unconscious and unresponsive ROSC present at least 5 minutes Systolic B/P >90 with or without pressor agent

use (i.e.: Dopamine) Airway has been secured

35

ROSC Contraindications

Major head trauma or traumatic arrest Recent major surgery within past 14 days Systemic infection (i.e.: septic shock) Coma from other causes Active bleeding Isolated respiratory arrest Hypothermia (34o C/93.2o F) already present

36

Induction of ROSC

Place ice paks in the axilla, neck and groinAreas where blood vessels tend to be superficial

Place ice pak over IV site If patient begins to shiver, contact Medical

ControlAnticipate order for Valium to stop the shiveringShivering will generate heat and therefore

increase body temperature

37

Vasopressor - Dopamine

Stimulates alpha, beta, and dopaminergic receptors based on dose provided

Starting dose 5mcg/kg/min IVPB up to 20 mcg/kg/min

Take patient’s weight and drop last numberMinus 2 from number leftLeft with rate to run IVPB in drops per minuteEx: 150 pounds; drop “0”

15 – 2 = 13 drops per minute

38

Dopamine cont’d

Dopaminergic effects at 2 mcg/kg/minRenal vasodilation to improve blood flow to kidneysKeep kidneys working, the body keeps working

Beta effects 5 – 10 mcg/kg/min Increases strength of myocardial contraction – squeeze

more blood out of ventricles Alpha effects at >20 mcg/kg/min

Severe vasoconstriction that diminishes blood flow to all tissues

39

AED (Automated External Defibrillator) Function

AED’s will Analyze rhythms Deliver a shock if indicated

Ventricular fibrillation (VF)Monomorphic and polymorphic VT if rate and R

wave morphology exceed preset values

Will not deliver a synchronized shock Can indicate loose electrodes / poor electrode

contact

40

AED Use in Pediatrics

Pediatric attenuator used to deliver lower energy doses to children (built into cables with peds pads)

1-8 year old Use pediatric pads if available No attenuator (peds pads)available, use standard AED pads

< 1 year old Manual defibrillator preferred If no manual defibrillator, use peds pads with attenuator No peds pads, use AED pads available

41

AED Use With CPR

Do NOT interrupt CPR to apply padsApply pads while CPR in progress

Do not touch patient during analysis phase Can provide compressions during charging phase No O2 flow across patient body during defibrillation

attempt Call and look “ALL CLEAR” prior to each defibrillation

attempt Immediately resume CPR

42

Transition From AED To DefibrillatorUpon arrival at scene, if AED ready to discharge, utilize

AEDDo not interrupt operation of device

During 2 minutes of CPR, can switch from AED use to monitor/defibrillator

Immediately resume CPR after delivery of each defibrillation attempt regardless of equipment used

43

Synchronized Cardioversion

A controlled form of defibrillation using a lower energy level that interrupts underlying reentrant pathway

Used with organized rhythms and in presence of a pulse Monitor interprets QRS cycle and energy delivered

during R waveLess vulnerable area of QRSDownslope of T wave is relative refractory area

Minimal stimulant could generate rhythm into VF

44

Indications Synchronized Cardioversion

Unstable tachyarrhythmiasSVTRapid atrial fibrillation or flutter

Hazard of breaking loose a blood clot in the atria and resulting in a stroke

Ventricular tachycardia

Note: polymorphic VT NOT likely to respond to synchronized cardioversion – no defined R wave

45

Synchronized Cardioversion Procedure

Apply padsAnterior/anterior or anterior/posterior position

Sedate if possibleThis is a painful procedure!Versed 2 mg IVP/IO; repeated every 2 minutes;

max 10 mg (desired effect – sedation!) Consider pain management

Fentanyl 1 mcg/kg IVP/IN/IO; may repeat in 5 minutes to max of 200 mcg total dose

46

Sync Procedure cont’d

Activate “sync” buttonVerify R wave is being flagged/identified

Choose energy setting starting at the lowest watt setting100j, 200j, 300j, 360j

Verify O2 not blowing across chest wall

Look (nose to toes) and call “ALL CLEAR” Press and hold sync buttons until energy discharged

Momentary delay waiting to identify the R wave

47

Sync Procedure cont’d

If synchronized cardioversion needs to be repeated, need to reset the “sync” buttonSafety that machine will default to defibrillation mode after

every discharge of energy

If VF occurs, verify sync mode is off and defibrillate patient without delay

48

Transcutaneous Pacemaker - TCP

Electrical cardiac pacing across the skin TCP is a painful non-invasive procedure so sedation

will most likely be necessary Indications

Symptomatic bradycardiaHypotensiveHypoperfusing

Evaluate level of consciousness and B/P for most reliable indicators of patient condition/stability

49

TCP Procedure

Apply pads (-) over apex of heart, anterior chest wall (+) mid upper back below left scapula

Set desired heart rate (80) Confirm sensitivity at auto/demand Begin mA current at 0 Turn pacer on

50

TCP Procedure cont’d Slowly increase output until ventricular capture

Spike followed by widened QRS Reassess vital signs and pain level Document settings – mA and rate Reassess need for sedation and analgesia

Valium 2 mg IVP/IO over 2 minutes; repeat every 2 minutes until max of 10 mg total dose

Fentanyl 1 mcg/kg IVP/IO/IN ; can repeat dose in 5 minutes with max total of 200 mcg

51

Critical Thinking Skill and TCP

In setting of acute MI, consider contacting Medical ControlMay want to decrease heart rate of TCP just

enough to maintain perfusion Want to avoid increasing the work load on the

heart by automatically selecting 80 as the heart rate Increasing work load on heart may increase the

size of the infarction

52

What would you do…

You applied the TCP for a symptomatic bradycardia You had a paced rhythm You notice the following rhythm strip change – what is the

rhythm and what would you do?

Reassess patient; increase mA; consider need for CPR

Failure to capture

53

Defibrillation During Pacing Mode

Check your device for specifics When in the pacing mode and the need to

defibrillate occurs, for some models, you may have to turn off the pacing mode

If pacing must be resumed, reset all levels

54

12 Lead EKG’s

A graphic recording of electrical activity in the heart Must evaluate the pulse to determine mechanical

response Single lead (i.e.: lead II) evaluates cardiac rhythms 12 lead views can diagnose an acute MI Early interpretation of 12 lead EKG early

diagnosing early reperfusion & restoring blood flow to ischemic tissues

55

Acute MI

Death of portion of heart muscle from prolonged deprivation of oxygenated blood

Heart’s demand exceeds supply of oxygen over extended period of time

Often associated with atherosclerosis process Location and size of infarct depends on vessel

involved and site of obstructionLeft ventricle most common site

56

Evolution of Acute MI

Ischemia – initial lack of oxygenST depression can be reversible

Injury to myocardial tissueST elevation can be reversible

Death/infarctionNecrotic tissue can lead to scar formation Irreversible processCan leave a positive Q wave marker in leads affected

57

58

AMI Process

Ring of ischemic tissue surrounds infarcted myocardium

Collateral circulation may develop Ischemic area often site of arrhythmia

development

59

Complications of AMI

Arrhythmia most common VF most lethalMost common cause of sudden death within one hour

of onset of signs and symptoms Destruction of myocardial muscle mass can lead to

CHF due to impairment of pumping capability Cardiogenic shock may develop if heart function is

inefficient and inadequate Ventricular aneurysm can develop due to damaged

wall of heart – can rupture causing instant death

60

Patient Assessment

Pain most common chief complaintLasts more than 30 minutesNot relieved by rest or NTG

Tired and weak most often complaint in elderly, long standing diabetic and women

Determine responses to OPQRST assessmentActivity at onset, provocation/palliation

(worsens/improves), quality in their words, radiation, severity on 0 -10 scale, time of onset

61

EMS Action

Apply monitor Examine underlying rhythm – document

rhythm Obtain 12 lead EKG

Evaluate for ST segment elevationIf elevation, in what group of leads?If depressed, look for reciprocal elevation

Watch for development of arrhythmias

62

Proper Placement EKG Chest Leads

63

Groups of Acute MI by Leads64

Identifying Groups of ST Elevation 65

Why Aspirin???

Inhibits platelets from aggregating/collecting at site of plaque rupture inside vessel wall

Decreases morbidity and mortality rate Chewed to increase breakdown and absorption time of

medication Patients on daily aspirin already have elevated and

acceptable blood levels of aspirin – don’t have to supplement a dose if absolutely sure they took one today

Always better to give full dose than to risk skipping any dose (just in case of skipped dose)

66

12 Lead EKG Procedure

Obtain rhythm strip Interpret, report and document rhythm Obtain 12 lead EKG

Identified with patient age, sex, department name in preparation for transmission

Review for ST elevation pattern Report to Medical Control what you see, then

read word for word interpretation on 12 lead EKG printout

67

12 Lead EKG Documentation

Interpret the rhythm strip and document on patient care run report

Document presence or absence of ST elevation If elevation, report and document in which

leads Provide copy of rhythm strip and 12 lead EKG

to ED secretary for placement on patient’s medical record

68

CPAP

Continuous positive airway pressure Effective therapy for acute CHF –

pulmonary edema Can avert the need for intubation and mechanical

ventilation if applied early enough Maintains constant pressure within the airway

and through-out the respiratory cycle Keeps alveoli open and expanded Increases surface space for diffusion of gases

69

CPAP cont’d

Buys time for other therapies (i.e.: medications) to work

PrecautionToo much pressure can

inhibit ventricular filling decreasing cardiac output

B/P can drop

70

CPAP Indications

Stable pulmonary edemaAlert; systolic B/P >90mmHg

COPD with wheezingFirst contact Medical Control for orders

For unstable pulmonary edema (altered mental status, systolic B/P <90 mmHg), contact Medical Control to discuss use of CPAP

Reminder: all therapies used in pulmonary edema have potential to drop the B/P

71

CPAP Contraindications

Respiratory arrest or apnea Pneumothorax or trauma to chest wall Tracheostomy present

Can’t get tight fit over trach stoma Actively vomiting

72

CPAP Procedure

Sit patient upright Assess and obtain baseline vital signs Begin O2 via non-rebreather mask while

setting up equipment Administer first dose NTG

Used as venodilator to decrease blood return to heart (decreases pre-load)

73

CPAP Flow Safe II Procedure

Assemble CPAP Flow Safe IIAttach proximal end of O2 tubing with

manometer to port in mask

Attach distal end of tubing to O2 source

Secure face mask snugly to patient’s face using head harness

Adjust O2 flow – 13-14 lpm for 10 cm H2O

Continue administration of medications

74

CPAP Procedure cont’d

Lasix 40 mg IVP (80mg if on med at home) as a diuretic If systolic B/P remains >90 mmHg

Morphine 2 mg IVP slowly over 2 minutesMay repeat 2 mg every 2 minutes as needed to max of 10 mgUsed to decrease anxiety and for benefit of vasodilation

If patient shows deterioration during CPAP treatment, remove CPAP, consider intubation, inform Medical Control

75

CPAP Tidbits Be prepared to coach patient through first few

minutes of CPAP use until positive effects beginPatient is already frightened Patient may feel suffocated with the mask onExhaling against the resistance is tough at first

76

HARE and Saeger Traction

Indicated for isolated mid-femur fracturesReduces muscle spasm and therefore pain levelReduces risk of bones overriding

ContraindicationsOpen fracture

Do not want to draw contamination into the wound

Hip, knee, or pelvic fracturesIncreased risk of nervous or vascular complications

77

Preparing for Traction Application

Assess motor/sensory/circulation before and after splintingCan you move this/can you feel that?Mark pulses once found – easier to find the site

on reassessmentCompare to uninjured side

Apply manual traction until mechanical traction in place

78

HARE Application

Measure and adjust splint Support distal end of splint on backboard Apply distal ankle hitch while maintaining

manual traction Position traction under injured extremity Secure proximal end to groin area Apply hook to ankle hitch Replace manual traction with mechanical traction

79

HARE Traction Adjust straps avoiding over the knee and over the injured

site

80

Saeger Traction Application

Support leg and maintain gentle traction Use uninjured leg to measure and adjust splint

length Place splint inside injure leg; padded bar snug

against pelvis in groin (watch pressure areas!!!) Attach strap to thigh Attach padded hitch to foot and ankle Extend splint until correct tension obtained Apply elastic straps to secure leg to splint

81

Saeger Splint

Do not place straps over fracture site

Release manual traction

Reassess distal pulse, motor, and sensory

82

Pain Control With Use of Traction

Fentanyl 1 mcg/kg IVP/IN/IOMay repeat same dose in 5 minutesMax total dose of 200 mcg

As a CNS depressant, watch the respiratory status If respiratory depression occurs, begin to support

ventilations via BVM1 Breath every 5 – 6 seconds Document 10 -12 breaths per minute assisted

Narcan 2 mg IVP/IN/IO can be used to reverse respiratory depression due to opioid use

83

Cleaning of Traction Splints

Rinse off gross contaminant Wet down all surfaces with Cavicide wipes Let device air dry Confirm all straps are accounted for and

repackage device in preparation for next patient

84

Combat Application Tourniquet - CAT Indications

Uncontrollable hemorrhage when usual means have failed

ContraindicationsNon-compressable site

EquipmentTourniquet with attached rod

85

CAT - Procedure

Apply tourniquet proximal to bleeding site as distal as possible; preferably over bare skin

Pull band very tight and securely fasten band back on itself

Twist rod until bright red bleeding has stoppedOr until distal pulses are eliminated

Place rod inside clip; locking into place Secure straps over clip holding rod

86

CAT – Potential Problems

Inability to control bleedingContinue with direct pressurePrepare to apply a second CATApply QuikClot dressing if available

Must be applied directly over wound site for impregnated material to be effective

87

CAT – Documentation Pearls

Reason CAT was applied Time and site of CAT application Results post intervention Consideration of administration of pain

medicationFentanyl 1 mcg/kg IVP/IN/IO

May repeat in 5 minutes, same doseMax 200 mcg total dosing

88

Midazolam - Versed

Potent, rapid onset, short acting benzodiazepineOnset 3-5 minutesDuration 20-30 minutes

Used as sedative and hypnotic Has amnesic properties and reduces anxiety

Amnesia of recent past (antegrade) useful to inhibit unpleasant reminders of procedures

Low toxicity and high rate of effectiveness

89

Indications for Versed Per Region X SOP’s

Sedation prior to synchronized cardioversion Useful to maintain sedation post drug assisted

intubation procedure Suppresses seizure activity

IN route allows safer delivery method Decreases severe anxiety and apprehension

90

Precautions With Versed

Crosses placental barrier – could cause respiratory depression in newly born infant

Elderly more sensitive to effects; metabolize med more slowly

Toxicity increases when mixed with CNS depressants (alcohol, opioids like Fentanyl, tricyclic antidepressants)

Toxicity may be higher in patients with COPD

91

Side Effects of Versed

Respiratory depression Drowsiness Hypotension

When administering, have a BVM readily available Be prepared to assist respirations

1 breath every 5 – 6 secondsDocument 10 – 12 breaths per minute assisted

92

Fentanyl

Synthetic opiate analgesic for pain control Shorter acting than morphine Onset immediate when administered IVP Peak effect 3 5 minutes Lasts 30 – 60 minutes Does not affect blood pressure like Morphine

does

93

Dosing For Fentanyl per Region X SOP’s

Adult1 mcg/kg IN/IVP/IOMay repeat same dose in 5 minutesMax total dose 200 mcg

Pediatrics0.5 mcg/kg IVP/IN/IOMay repeat same dose in 5 minutesMax total dose 200 mcg

94

Precautions With Fentanyl

Crosses the placental barrier – could cause respiratory depression in newly born infant

Monitor respiratory rate, SpO2 levels, and level of consciousness

Have BVM available to counteract potential respiratory depression1 breath every 5 – 6 secondsDocument 10 – 12 respirations per minute

95

Cleaning of Equipment – After Every Patient Use In general, each piece of equipment in contact with a patient

MUST be cleaned between each patient use Gross contaminant must be removed Surfaces need to remain wet and allowed to air dry All cables need to be wiped down (i.e.: EKG, B/P, pulse ox)

Cables drag across contaminated surfaces A LOT!!! B/P cuffs need to be wiped down Pulse ox sensors need to be cleaned following manufacturer

recommendations

96

Department Review of Equipment

Review set up of capnography monitoring Review operation of monitor/defibrillator for

defibrillation, synchronized cardioversion, and TCP

Review procedures for transmission of 12 lead EKG to receiving hospital

In teams, apply the HARE or Saeger traction device to a peer

97

Bibliography

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

Campbell, J., International Trauma Life Support for Emergency Care Providers. 7th Edition. Pearson. 2012.

McDonald, J. ALS Skills Review. AAOS. Jones and Bartlett. 2009.

Mistovich, J., Karren, K. Prehospital Emergency Care 9th Edition. Brady. 2010.

Pediatric Education for Prehospital Professionals 3rd Edition. American Academy of Pediatrics. 2014.

Region X SOP’s; IDPH Approved January 6, 2012. www.MARescue.com

98