2019 EMT Refresher Instructor Manual

A.2.B - Nebulizer / NRB / SPO2 (~13 minutes)

Objectives: Demonstrate the use of a non-rebreathing mask, nebulizer, and pulse oxymeter

Setup: - Oxygen system with NRB, nebulizer, fake albuterol ‘bullets’ - Good quality BLS manikin - ET3 (ideal) or pulse oxymeter

Instructions to be read to students: “I am going to demonstrate how to assemble a nebulizer and run you through a quick vignette on using them”

Precautions: Do not let the station deteriorate into chatter. Continue rotating them through one at a time until everyone has done the scenario.

Please note the following:

This station is about demonstrating NRB competency and administering albuterol by nebulizer (new skill!).

Nebulizer– This device aerosolizes medication, and EMTs can continue a nebulizer treatment the patient has already begun prior to EMS arrival. Have the EMTs assemble the nebulizer and place the contents of an “albuterol” bullet in the medication tray to create vapor so the EMTs can see it. The limitations of this intervention is that the patient must already be diagnosed with COPD or asthma and have shortness of breath.

“Your patient is 32 years-old and is short of breath with moderate distress. Please administer oxygen to this patient.”

Takes appropriate BSI Gathers appropriate equipment Cracks valve on oxygen tank Assembles regulator to the oxygen tank Opens tank valve / Checks oxygen pressure

Critical Criteria: ____ Did not take, or verbalize, BSI procedures ____ Did not correctly assemble nebulizer ____ Delivers incorrect dose of abuterol

Attaches non-rebreather mask to correct oxygen port Turns on liter flow to 10+ lpm and prefills reservoir bag Attaches mask to patient’s face and adjusts snugly

Places SPO2 probe on patient finger Correlates heart rate with radial pulse Examiner informs the candidate that the patient is dyspneic, wheezing and has a history of asthma Assembles nebulizer system Empties one albuterol 2.5mg ampule into nebulizer chamber Attaches nebulizer to oxygen delivery system and sets oxygen to 6 lpm Places device on patient’s face Examiner asks candidate what reassessments would be indicated in this scenario Candidate states he/she would reassess breath sounds and breathing difficulty