Just about every 24 hour shift that I work up in my Northern job I put together a little impromptu training session. Itís a way for me to address things that I think are important for the crews to†refresh on as well as a way for me to read up on some things and make sure I remember the stuff I should know. I†try to learn the latest things on the chosen topic with a bit of research†before I present the class as well. It keeps me sharp, which is good.
Also, (and letís talk about the important things here) it gives me a cheap and easy blog post which I like because Iím really trying to bump up my posting frequency with this Fancy New Blog and all that.
Todayís training topics were a refresher class on intravenous access as well as BLS Airway Management†Skills. We have a good number of EMT-Basics, EMT-IV Techs (here in Wisconsin) and even an EMT-Intermediate Ď99 that are on-duty today. My partner and myself (incidentally, both named Chris) are the duty medics.
So, without further ado, hereís what I taught†them. Remember, this was a BLS class, and is geared to newer providers.
- IV Skills: I didnít do anything on my own here. One of the benefits of the EMS blogosphere is that I have a wealth of training information at my fingertips. A lot of the time, Iíll pop on over to see what Greg Friese is doing on Http://www.everydayEMStips.com†Ė And if Iíd like some in-depth EMS knowledge, Iíll head over to Http://paramedicine101.blogspot.com.
For this training, however, I took the tips laid out by Steve over at Http://www.theEMTspot.com†Ė where he wrote ďSix Techniques to Nail the IV Every TimeĒ I put it up on the projector and wrote down the bullet points on the white board. (and I gave him the credit for the easy and valuable training both in the class and on here)
- BLS Airway Management knowledge:
For this one, I pulled out every airway and oxygenation management tool we carry in the truck, which in my service includes:
- The Oropharyngeal and Nasopharyngeal Airways
Do you know when to use one over the other? Hereís some tips. First, if the patient is unresponsive enough to†take an oropharyngeal airway without triggering a massive gag reflex, the patient NEEDS an oropharyngeal airway. (or an ET tube/Combitube/King LT for that matter)
Nasopharyngeal airways are used for patients unresponsive enough to need an airway adjunct but that still have an intact gag reflex. DO NOT USE nasopharyngeal airways in cases of head or facial trauma. (Why? Because the nasopharynx is separated from the rest of the cranial vault by the Cribiform plate, which is a very thin piece of bone that can be fractured very easily with significant head trauma. If it is fractured, you run the risk of placing the nasopharyngeal airway†Ė or the nasogastric tube for that matter†Ė right into the cranial vaultÖ which is bad.†
The oropharyngeal airway is measured from the corner of the mouth to the angle of the jaw. The Nasopharyngeal airway is measured from the nare (nasal opening) to the earlobe.
On a side note, do you know how to check for a gag reflex? My almost never-fail method is to use the eyes. If the patient is unresponsive, running your finger lightly through their eyelash should elicit a response (i.e. wiggling) if the patient has an intact gag reflex. Further, a variation on the theme is to lightly open their eyelids with your gloved fingers and lightly blow into their eye. Donít do it hard, and certainly donít blow hard or use any pressure with your fingers, but if a person isnít unresponsive and can tolerate that without flinchingÖ they arenít human.
- The Combitube
Honestly, Iíve not had a good track record with the combitube. I prefer the King LT. (Sorry Happy)
- The Endotracheal Tube
For this part of the training I looked at the various†parts of this procedure†that an EMT-Basic might be asked to participate in, such as preoxygenation with a BVM before the procedure, setting up the equipment for the ALS provider before he/she needs it, choosing the various adjuncts to assist the ALS provider in confirming tube placement, and various methods to secure the tube.
This is a miracle treatment. CPAP, or Continuous Positive Airway Pressure has revolutionized the management of congestive heart failure and pulmonary edema. Every EMT should know how to use this, when to use this, and how to properly apply this wonderful thing.
- Non-Rebreather O2 mask, Nasal Cannula (Adult and Peds)
If you donít know how to use this, you probably should.
- The Nebulizer set up (We use Albuterol (Proventil) and Ipatropium Bromide (Atrovent)
We covered the proper set-up of the nebulizer and the various differing ways that it can be employed. Sure, you can use the duckbill for the patient to hold, but you can also pull the reservoir bag off of a Nonrebreather mask, insert the nebulizer chamber where the bag went and youíve got yourself a handy mask neb.
We also went over the proper way to connect the nebulizer to the Bag Valve Mask. Depending on your equipment this setup could vary. Ours did like 3 ways. Check yours.
- Bag Valve Masks of assorted sizes
Learn how to properly seal the masks, the proper ventilatory rate (8-10 per minute) and the proper size for each variation in patient population.
- A Pocket Mask
Havenít used one of these in a while, have you?
- The Surgical and Needle Cric kits
The basics donít need to know how to use these, but itís good to practice. Three of us had to hold the student†down to do it, but we got it in on the second try!
Iím really liking my new home.