Disaster Drill AAR

In the Army, we have this thing called an AAR - after action review.  It gives the commanders and the soldiers an opportunity to talk about training, what was supposed to happen, and ways to improve for the future.

Now that a couple weeks have passed, I'd like you guys to provide me some feedback on the disaster drill.  What did you like?  What didn't you like?  What can be done better for next time?

I hope you guys enjoyed it and got some good training, but I want to make sure it is improved for next years class!

Summertime!

Class:

As we talked about last week, instead of doing a weekly blog during the summer, I will be expecting each of you to complete some FEMA online training.  The link below is where you can access the courses and the final exams:

http://training.fema.gov/IS/NIMS.asp

Please complete the following courses:

IS-100(b)
IS-200(b)
IS-700(a)
IS-800(b)

At the end of each course, there will be final examination and once you pass that, FEMA will e-mail you a course completion certificate.  You will need to send those to me or give them to me in person as you see me.  All of this courses will need to be completed by 0800 on 08 September 2012 before we start work on disaster management and completion of the mock disaster drill.

If anyone has any access problems or gets stuck in any way, please call or e-mail me.  Each of these courses takes about 90 minutes each, so it would behoove you to not wait until Friday the 7th to start working on them.  Each certificate is worth 30 points, or the equivalent of 3 weekly blogs. 

Week 14 - Care to guess?!

It occurred to me this morning as I was about to post your week 14 blog, that maybe it was time for a little break!  As such, I want you each to e-mail me a short status update about how you are marching through Cardiology and what you need some extra help on.  I have a couple classes coming up that I am going to be teaching, so if you have any suggestions of stuff to go over to help you guys understand something more, please let me know!

Week 13 - Cardiac Ablation Procedure

Watch the following video on Cardiac Ablation, and then answer the questions below.  Your responses are due NLT 26 APR 12.

http://www.youtube.com/watch?v=ubK1n9F1aFY&feature=relmfu

1.  About how long does a typical cardiac ablation procedure take?
2.  What is the function of the blue wire?
3.  What is the function of the red tube?
4.  How long does the actual ablation usually take?
5.  How long is a typical hospital stay for the procedure?

Week 12 - GIK Study

Class:

Below is a link to an article that was published by JEMS (Journal of Emergency Medical Services) in late March.  This article discusses a clinical trial that was conducted with a cocktail of drugs called GIK.  Please review the article, and write a short summary of the results of the study and how it could affect you as future Paramedics.

This assignment will be due NLT 19 APR 2012.

http://cl.ly/0y3j1o2c2C330f1f2U1A

Week 11 - HAPPY EASTER!

 Please watch the video below on the Cardiac Conduction System and then answer the questions that are listed below. 

Your responses are due to me NTL 12 APR 2012.

http://www.youtube.com/watch?v=fUQJTEEJSPI

1.  What does the term "action potential" represent?
2.  In a normal heart, each beat begins where?
3.  Which node is the hearts natural pacemaker?
    a.  AV Node
    b.  SV Node
    c.  SA Node
    d.  VS Node
4.  Which segment of the EKG represents depolarization of the ventricles?
5.  Ventricular repolarization is represented by what on the EKG?

Week 9 - Legal & Operational Drug Issues

Week 9 – Legal & Operational Drug Issues

A couple weeks back we listened to a Podcast from Dr. Jeffrey Guy with the Vanderbilt School of Medicine.  Just a heads up, you’ll be hearing his voice a lot over the next several months because some of the information he delivers is extremely valuable, and as the course proceeds I intend to expose you to more of his podcasts.

The podcast for this week deals with some of the legal issues surrounding the drugs we give.  As we start our basics of pharmacology, there is some vital information that you should be aware of as we advance through the course.

A link is provided below and then some questions at the end for you to answer and reflect upon what you’ve heard.

This blog will be due NLT 5 April 2012.

Link

http://cl.ly/2t2T3u2p2d422d1S232c

Practical Exercise

1.     Dr. Guy provides a comparison between the medications we give and the “tools” that rescue personnel carry.  Do you agree with this?  Why or why not?

2.     The shelf life of medications is based on many factors.  Which is NOT a factor?

a.    Chemical composition of the drug;

b.    Stability or volatility;

c.     Medication half life;

d.    Expected period of effectiveness.

3.     Administering a medication that has been exposed to extremes in temperature (being hot or cold) does not benefit the patient.  If the paramedic administers one of these drugs, which of the following can happen?

a.    Patient has an allergic reaction;

b.    Paramedic could be liable for negligence;

c.     Paramedic could face disciplinary action;

d.    Patient develops hypotensive crisis.

4.     Dr. Guy refers to the ABCs and says he has his own version, the IABCs.  What does the “I" stand for and why does he include it

5.     While performing your morning check off, you note that a seal on a vial of Morphine has been compromised.  The medication was not used during a call the shift before and the outgoing crew did not share this mishap with you.  If you are affiliated with an agency, share what your agencies policy is on this.  If you are not affiliated, tell me what you would do in this particular instance. 

Week 8 - Obtaining a Blood Sample

Week 8 – Obtaining a Blood Sample

Obtaining a blood sample is not something that Paramedic’s typically perform in the field, however it is something that you will see a lot of during your clinical times.  There is a meaning and purpose to those little tubes with colored tops on them, and the attachment below will walk you through some steps on obtaining a blood sample, and also break down what the purpose of each tube is.  Review the document and answer the questions below.

http://cl.ly/3q2g1m3C422D3k0Z3l0b

Practical Exercise:

1.     Why are venous blood samples typically performed?

2.     If no IV line is present, what would you want to use to obtain the blood sample?

3.     What tests are done on the green blood sample container?

4.     Which tube is not inverted after obtaining the sample and why?

5.     EDTA tubes are used to collect what type of sample?

Week 7 - REST!

This is one of those blogs I promised you, where its nice and easy and you guys can take a rest!  I know you had your first test on Wednesday (07 MAR 12), so I want you to each provide me with some feedback on how you felt you did, and how you intend to improve for the next test.

Relax, there is no right or wrong answer, but I want you each to take a few minutes and reflect on how your first test went.  Stating more than "I just need to study more" would be advisable. 

I expect responses NLT (no later then) 15 Mar 12.

Week 6 - Tracheotomy

Below is a link to a YouTube video that shows a surgical trach being performed (don’t laugh too hard at the Lady GaGa playing in the background – I certainly did.  Surgical trachs aren’t typically performed in the field as a Paramedic, but there are some jurisdictions and cases where you may be called on to perform this skill, so it is vital to understand.

http://www.youtube.com/watch?v=E8irjJ4yMMg&feature=related

Below is a link to a document that talks a little bit about tracheotomy emergencies.  Read the document, and answer the questions below.

http://cl.ly/0Y1U1V3K0A1u393g2O2r

This blog will be due to me NLT (no later than) 8 March 2012.

Practical Exercise:

1.     What are the three (3) ways listed to help prevent a blocked tracheotomy tube?

2.     How does a cuffed tube cause damage to the trachea from a tracheotomy?

3.     What is a good measurement tool to assess that tape around a tube is not too tight, but is still securing the tube adequately?

4.     In the video of the surgical tracheotomy, what is causing the bubbles when the trachea is first cut?

5.     After the endotracheal tube is removed, what action follows?

Week 5 - Intro to RSI

Week 5 – Introduction to RSI

RSI, or Rapid Sequence Intubation, is the process of chemically paralyzing someone so that they can be intubated to protect their airway.  This technique couples sedation to induce unconsciousness (induction) with muscular paralysis.

Below is a link to a podcast done by Dr. Jeffrey Guy who is a professor of surgery and director of the burn center at Vanderbilt University School of Medicine.  Please listen to the podcast and then answer the questions that are listed below.  

Link:

http://cl.ly/0F0R3v2F322k30450G1p

Practical Exercise

1.     What does Dr. Guy say are the key components that are listed to this technique:

a.    Short acting Barbiturates and muscular paralytics

b.    Provider knowledge and proper equipment

c.     GCS < 8 and supporting MOI

d.    Proper medications and supporting protocols

2.     RSI has three goals.  Which of the following is not a goal of RSI:

a.    Overcome potential barriers of intubation;

b.    Provide protection to normal physiological responses to intubation;

c.     Provide humane conditions;

d.    Increase and stabilize vital signs in traumatic patients.

3.     3. What is the different in goals between Rapid Sequence Induction and Rapid Sequence Intubation?

4.     Before administration of the drugs to perform an RSI, which equipment is NOT necessarily required to be nearby and ready:

a.    Functional suction and O2 supply;

b.    Functional laryngoscope;

c.     Medical Control authorization;

d.    End tidal CO2 and pulse oximetry

5.     What are some anatomical problems that could interfere with an ability to provide ventilations via BVM to the patient?

a.    Cold sores or snoring respirations;

b.    Dentures or Hemiglossectomy;

c.     Facial hair or facial trauma;

d.    Cleft lip or cleft palate

Week 4 - Respiratory Distress

Week 4 – Respiratory Distress

Respiratory distress is a common finding in many patients who call for EMS. There can be many causes including dyspnea, hypoxia, hypercapnia and cyanosis. Despite any fancy tests that can be performed on a patient, the evaluation of respiratory distress depends on careful history and physical examination of the patient. Discussed below are three commons causes of respiratory distress, along with the potential causes of each.

Dyspnea
Dyspnea is the subjective finding of difficult, labored or uncomfortable breathing. There is no single mechanism that causes dyspnea, however most patients will have a cardiac or pulmonary cause.

Common causes include obstructive airway, asthma, COPD, CHF, Unstable Angina/MI and Pneumonia. The most immediately life threatening causes include upper airway obstruction, tension pneumothorax, pulmonary embolism, neuromuscular weakness, and Gullian-Barre syndrome.

Hypoxemia
Hypoxemia is the inadequate delivery of oxygen to the tissues. Oxygen delivery is mainly a function of cardiac output, hemoglobin concentrations and oxygen saturation. Hypoxemia typically results from a combination of five distinct mechanisms:

Hypoventilation hypoxia in which lack of ventilation increases PaCO2, thereby displacing it from the alveolus and lowering the amount delivered to the alveolar capillaries;
Right-to-left shunt in which blood bypasses the lungs, thereby increasing the amount of unoxegenated blood entering the systemic circulation;
Ventilation/perfusion mismatch in which areas of the lung are perfused but not ventilated;
Diffusion impairment in which alveolar-blood barrier abnormality causes impairment of oxygenation;
Low inspired oxygen, typically occurring at high altitudes.

Hypercapnia
Hypercapnia is defined as a PaCO2 above 45 and is exclusively due to alveolar hypoventilation. Factors that affect alveolar ventilation include respiratory rate, tidal volume and dead space volume.

Signs and symptoms can depend on the rate of change and the absolute value of PaCO2. Acute elevations result in increased intracranial pressure, which causes patients to complain of a headache, confusion and lethargy. In severe cases in which the PaCO2 acutely rises above 80, coma, encephalopathy and seizures may be present.


Practical Exercise
1. Your patient is a 35 year old female, who called EMS stating that she was having some difficulty catching her breath. Vital signs are within normal limits, and your assessment reveals that patient is complaining of some nausea and a headache. She is also sluggish to answer your questions.

2. What do you suspect this patient could be suffering from and why?
While performing your assessment, what are some ways you could distinguish between Hypoxemia and Hypercapnia?

3. What would your treatment plan include for the above referenced patient?

Patient Assessment - Week 3

Patient Assessment – Week 3

Knowing how to perform a patient assessment is one of the most vital tools of the Paramedic.  It helps you to answer vital questions like who, what, when, and how about the patient and the surrounding scene. No matter the call, no matter the patient, the EMS provider needs to be able to rapidly zero in on a complaint, make a working diagnosis, and provide adequate treatment for the patient’s condition.  If you don’t know what is going on with the patient, how are you going to provide them with adequate treatment?

Below are some tricks that you can use to ensure you are performing a great assessment:

1. Just Do It! – Remember, you can’t over-assess your patient. The more information you get the better. Every patient gets a full assessment, every time. Even if you can’t act on the information you gather, the information could prove invaluable to healthcare providers further down the road. They need good information on the acute phase of the patient’s illness. Remember, the Paramedic is “the eyes and ears of the physician in the field.”

2. Standardize! – Develop your own version of the standard assessment and do it every time.  Think up a set of questions you want to know the answers to about your patient, and answer them every time. Not only will practicing the assessment get it down to a science, you’ll also get very quick at it.  Me personally, I take a temperature and blood glucose on every patient I come into contact with.  Other information such as last tetanus shot, last flu shot, last menstrual period and pts primary doctor will make your own and the receiving facilities report writing much easier. 

                                                    

3. Start your assessment the second you arrive on scene – Start gathering information about the patient immediately.  The assessment should be performed constantly and not just at any one specific point in your contact with the patient.  It should be performed multiple times based on the changing condition of your patient. 

4. Check THESE THREE THINGS when you first encounter the patient – Always introduce yourself to the patient using your name and while you’re doing this, feel their radial pulse with your fingers. This tells you three immediately important things that will drive the rest of your care: The status of their Airway, Breathing, and Circulation. You’ll feel the rate and quality of their pulse; feel their skin temperature, moisture, and condition; and be able to assess their work of breathing when they answer you back from your introduction. If any of these things are compromised then the patient is probably sick and in need of intervention.

5. Try to determine the patient’s ultimate diagnosis – As you progress through the Paramedic class, your knowledge of the body and the various systems within it will increase dramatically.  All of this instruction is so that you can make your own field diagnosis, so that you can start treatment and interventions that could potentially save the patients life.  EMS is an extension of the doctor’s treatment, and most of the time we are the first step in a much longer process.

  

6.     Don’t afraid to touch the patient – You’re a medical person. Medical people touch other people. Sometimes they see them naked. Sometimes it’s uncomfortable and sometimes you have to touch them in a way that wouldn’t otherwise be socially acceptable. Of course, don’t do anything wrong, illegal, or immoral… but when you’re checking for a broken leg you have to touch the leg. Actually look at, listen to, and feel your patients, but always maintain your professionalism. 

Practical Exercise

Start writing your own patient assessment form, and share with me some questions you would want to ask your patient during your assessment.  Provide some insight, whether it is book knowledge or practical field knowledge, which causes you to want to ask those questions. 

Stress - Wk 2

Stress – Week 2

Stress is a mind-body arousal that can save our lives, but can also fatigue the body systems to the point of malfunction and disease.  It can be motivating, energizing, exciting, fun and challenging.  In physical terms, stress means strain, pressure or force on a system.  It is the body’s way of reacting to its environment through the buildup of internal pressure and strain of muscles tensing for action. 

Stress can be both positive and negative.  It is negative when it exceeds our ability to cope, therefore fatiguing the body systems and causing behavioral or physical problems.  It is positive when it forces us to adapt and therefore increases the strength of our adaptation mechanisms.  It is also positive when it warns us that we are not coping well and that a change in our lifestyle is warranted. 

Critical incident stress occurs following a significant incident that personally affects a provider.  It causes his or her normal coping mechanism to be overwhelmed, and the basic adaptive functioning is overwhelmed.  When this stress is not dealt with in a timely, health manner, Post Traumatic Stress Disorder or PTSD can occur.

Post Traumatic Stress Disorder is a condition that develops after someone has experienced a life changing or life-threatening event.  In order for PTSD to develop, the event must have involved actual or threatened death or serious injury, and must have caused an emotional reaction of intense fear, hopelessness or horror.  People who develop and are diagnosed with PTSD often re-experience the event over and over again, tend to avoid people or places that remind them of the event, and often feel on edge all the time.  In severe cases, difficulties in concentrating, irritability and self-blame can complicate treatment options.

Although PTSD is sometimes harder to avoid after major traumatic events such as 9/11 or being on a battlefield in Iraq or Afghanistan, there are several steps that can be taken to ensure smaller events doing overwhelm our normal coping abilities.  Many EMS agencies will implore the use of Critical Incident Stress debriefing after a particularly horrifying event has occurred.  I personally have attended CISD once, following a car accident I responded to the night before Thanksgiving in 2009.  I found the format and the discussion to be particularly helpful.

Practical Exercise

Below is a link to a seven-day muscle relaxation plan.  Follow the directions in the plan, and perform it over the next week.  This blog will have an extended deadline of next Thursday, 8 February 2012.  Record your experiences and send me one e-mail next week outlining if this helped you deal with any tension you might have had. 

https://docs.google.com/open?id=1m30iJA1CZhgPonWNQ_dbBeBD827OqpWoOHp5WmkeiLNxSwfdqprO4aM2s127