October 2016 EMS CE: Respiratory assessment, capnography

October 2016 EMS CE: Respiratory assessment, capnography

OCTOBER 2016 EMS CE: RESPIRATORY ASSESSMENT (ADULT), CAPNOGRAPHY IDPH Site Code: 107200E-1216 Teresa Ehrhardt BSN, RN, TNS

OBJECTIVES Upon successful completion of this module, the EMS provider will be able to: 1.Discuss the steps necessary to perform an assessment of the patients respiratory system. 2.Interpret lung sounds when presented with a variety of audible recordings. 3.Choose the appropriate Region X SOP intervention based on scenario presentation of respiratory complaint. 4.Review the benefits of capnography and how it is used in the field.

5.Justify a diagnosis based on the waveform capnography reading and patient signs and symptoms. 6.Actively participate in group interpretation of a variety of waveforms for capnography. 7.Actively participate in ventilating a manikin at the appropriate ventilation rate for the situation. 8.Successfully demonstrate the correct ventilation rate via BVM and via an advanced airway device. 9.Successfully demonstrate measurement and placement of an oropharyngeal and nasopharyngeal airway in a manikin.

10.Successfully demonstrate the ability to assemble nebulizer kits for in-line administration 11.Successfully complete the post quiz with a score of 80% or better. RESPIRATORY A & P UPPER AIRWAY

LOWER AIRWAY GAS EXCHANGE RESPIRATORY ASSESSMENT IN

THE ADULT RESPIRATORY ASSESSMENT CONSISTS OF 3 PARAMETERS Respiratory Rate Respiratory Effort Quality of Respiration Assessed by

Inspection (Visualization) Palpation (Feel) Percussion (Tap) Auscultation (LISTEN) INSPECTION

Form your general impression (LOOK!) Chest Is it uniform? Is the chest wall movement symmetrical? Is the A-P diameter large?

Is there any sign of trauma? PALPATION Feel Feel Feel Feel

Feel for for for for

for abnormalities tenderness loose segments crepitus

vibrations (fremitus) PERCUSSION Determine if underlying tissues are air filled, fluid filled, or solid Determine the position of the diaphragm

Note if percussion is different on one side AUSCULTATION Listen to the chest Evaluate sounds heard Differentiate between vesicular and adventitious

breath sounds LETS LISTEN Common Lung Sounds

PUTTING IT ALL TOGETHER Video CAPNOGRAPHY

Understand M-V-P Metabolism Ventilation Perfusion CAPNOGRAPHY

Why Capnography??? CAPNOGRAPHY WAVEFORMS RESPIRATORY EMERGENCIES

Airway Obstruction, Pulmonary Edema, COPD, Asthma UPPER AIRWAY OBSTRUCTION Tongue Foreign body Trauma

Burns Allergic reaction PULMONARY EDEMA Cardiogenic pulmonary edema Non-cardiogenic pulmonary edema

Causes Presentation Tests and studies Treatment Video

COPD Chronic Obstructive Pulmonary Disease Symptoms Causes Risk Factors Complications

Treatment ASTHMA Symptoms Causes Risk Factors

Complications Treatment READY, SET, Scenarios

SAMPLE SCENARIO Its 3 am and you are called to a residence for a 64 year old man in respiratory distress. You find him sitting up in bed with feet dangling off the end. He presents in obvious distress and cannot speak due to the shortness of breath. Lung fields are very diminished with crackles. He is pale,

diaphoretic, and appears to be getting weaker. Family tells you that he has a bad heart and takes a heart pill, and a water pill. While in your presence the pt becomes obtunded with labored breathing. He still has a gag reflex. SCENARIO CONT

SKILLS STATIONS Intubation BVM Ventilation Capnography Airway Adjuncts- Nasopharyngeal and oropharyngeal airways

Nebulizer assembly REFERENCES https://acls-algorithms.com/waveform-capnography/ http://what-when-how.com/wp-content/uploads/2012/04/ tmp2A92_thumb221.jpg

https://vanessajunkin.files.wordpress.com/2013/06/waveform.jpg http://www.mayoclinic.org/diseases-conditions Bledsoe, Porter, Cherry. Paramedic Care Principles & Practice 4th Ed. Brady. 2013.

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