EMT Lesson Plans

Unresponsive Breathing 1 Patient is a 18-year old with head injury Takes appropriate BSI Gloves Scene Size-Up Determines safety Safe MOI / NOI MOI – head injury Number of patients 1 Requests additional help ALS Stabilization of the spine Yes Primary Survey/Resuscitation General impression Young person face down on ground near skateboard Responsiveness/LOC Unresponsive Determines chief complaint Unresponsive Assess airway and breathing Patent Breathes 10 / minute Assess circulation No bleeding, pulse present at wrist, skin warm dry Identifies patient priority High Vitals SAMPLE(bystander) BP: 182/106 S – Head injury- Unresponsive Pulse: 48 A – None Respirations: 10/min M – None P- None L–Sandwich 2hr ago Critical Criteria Did not take safety or BSI precautions Fails to request ALS Did not fully assess airway Did not fully assess breathing Did not fully assess circulation, including pulse and skin Is there a need for oxygen in this patient? Is there a need for an airway in this patient? (yes – unresponsive) Is there a need to bag this patient? Why? (borderline – probably not but needs monitoring What problems could be present? (head injury) Debriefing Points: E – Skateboarding with no helmet and fell and hit head

Unresponsive Breathing 2 Patient is a 28-year old – called for seizure Takes appropriate BSI Gloves Scene Size-Up Determines safety Safe MOI / NOI NOI - Seizure Number of patients 1 Requests additional help ALS Stabilization of the spine None Primary Survey/Resuscitation General impression Young person supine on floor of home Responsiveness/LOC Pain only Determines chief complaint Unresponsive Assess airway and breathing Patent (will reject oral airway) Breathes 12 / minute Assess circulation No bleeding, pulse present at wrist, skin warm dry Identifies patient priority High Vitals SAMPLE(bystander) BP: 106/68

Unresponsive Breathing 3 Patient is a 32-year old – called for unconscious at a workplace Takes appropriate BSI Gloves Scene Size-Up Determines safety Safe MOI / NOI

Unresponsive Breathing 4 Patient is a 82-year old – called for fever at nursing home Takes appropriate BSI Gloves Scene Size-Up Determines safety Safe MOI / NOI NOI - fever Number of patients 1 Requests additional help None Stabilization of the spine None Primary Survey/Resuscitation General impression

NOI - unconscious

Number of patients Requests additional help Stabilization of the spine

1

ALS

None

Primary Survey/Resuscitation General impression Adult collapsed on desk Responsiveness/LOC Verbal only (rejects OPA) Determines chief complaint Unresponsive Assess airway and breathing Patent Breathes 14 / minute Assess circulation No bleeding, pulse present at wrist, skin pale sweaty Identifies patient priority High Vitals SAMPLE(bystander) BP: 106/68 S – He got sweaty and shaky and confused. Now he is like this Pulse: 102 A – None Respirations: 12/min Critical Criteria Did not take safety or BSI precautions Fails to request ALS Did not fully assess airway Did not fully assess breathing Did not fully assess circulation, including pulse and skin Is there a need for oxygen in this patient? Is there a need for an airway in this patient? (yes – unresponsive) Is there a need to bag this patient? Why? (not at this time) What could be going on? (diabetic emergency) Debriefing Points: M – Insulin P- Diabetes L– toast 6 hours ago E – We were working on a project at work

Elderly person in nursing home bed

Responsiveness/LOC Determines chief complaint Assess airway and breathing Assess circulation

Verbal only

Unresponsive

Patent Breathes 14 / minute No bleeding, pulse present at wrist, skin hot and dry SAMPLE(nurse) S – He has a temp of 103.2 M – Lopressor, coumadin P- Hypertension, previous stroke (this is has baseline state), A-Fib L– Peg Tube feeding 1 hour ago E – he was just lying in bed A – Penicillin High

Identifies patient priority

Vitals

BP: 122/72

S – He was shaking pretty hard up to a minute ago

Pulse: 108

Respirations: 14/min

Pulse: 102

A – I don’t know M – I don’t know P- I don’t know L– I don’t know

Respirations: 12/min

E – We were watching TV

Critical Criteria Did not take safety or BSI precautions Fails to request ALS Did not fully assess airway Did not fully assess breathing Did not fully assess circulation, including pulse and skin

Critical Criteria Did not take safety or BSI precautions Did not fully assess airway Did not fully assess breathing Did not fully assess circulation, including pulse and skin Debriefing Points: Is there a need for oxygen in this patient? (probably not) Is there a need for an airway in this patient? (no – this is normal for him) Is there a need to bag this patient? Why? (no evidence of that at this time) With patients who are institutionalized or have special needs, getting baseline is super-important

Debriefing Points:

Is there a need for oxygen in this patient? Is there a need for an airway in this patient? (yes – unresponsive) Is there a need to bag this patient? Why? (not at this time) What could be going on? (post ictal state)