EMS Equipment
Review
MARCH 2015 CE
CONDELL MEDICAL CENTER EMS
SYSTEM CE
IDPH SITE CODE #107200E-1215
PREPARED BY: SHARON HOPKINS, RN, BSN, EMT-P
1
Objectives
2
Upon successful completion of this module, the EMS
provider will be able to:

List indications for use of a variety of EMS equipment
used in the field.

Manage a group of peers in setting up and applying
a variety of equipment used in the field.

Evaluate the effectiveness of application of a variety
of EMS equipment in a practical setting.
Objectives cont’d

3
Actively participate in review of selected Region X
SOP’s as related to the topics presented.
Actively participate in review of the process of
transmission of 12 lead EKG’s using department
specific equipment.
 Actively participate in reviewing the operation of your
department monitor/defibrillator, pacing capacity,
synchronized cardioversion
and defibrillation at the paramedic level.

Objectives cont’d

Actively participate in HARE/Saeger traction
application.

Successfully complete the post quiz with a score
of 80% or better.
4
Equipment and Patient Interventions 5
 There
comes responsibility when using equipment in
the delivery of patient care. You need to:
 recognize
what the problem is to know what to do
 be able to distinguish what the appropriate intervention(s)
is/are
 understand how to properly apply and use the equipment
chosen
 recognize when the intervention is working as well as not
accomplishing the goal
 know what documentation must be done with each piece
of equipment used in patient care
 be knowledgeable regarding the cleaning and returning
to service for each piece of equipment
Capnography Background

A continuous, non-invasive monitoring tool

Measures level of CO2 at end of exhalation
 Quantitative
results provides a number

Assesses respiratory status thru-out respiratory cycle

Provides current, at the moment, breath-to-breath
information on patient status

Results measured as mmHg of CO2
 Normal
35 – 45 mmHg
6
Capnography Information

Numeric value provides end tidal (end of
breath) CO2 level

Waveform is a picture representation of the CO2
value exhaled with each breath

Airway status reflected in:

ETCO2 value (mmHg)

Waveform picture

Respiratory rate
7
Definitions

Ventilation
 Process

of breathing; eliminating CO2 from body
Respiration
 Exchange

Oxygenation
 Getting

of gasses at alveoli level
O2 to tissues; measured by pulse oximetry
Diffusion
 Process
by which gas moves between alveoli and
pulmonary capillaries (gases move from area of high
concentration to areas of low concentrations)
8
Capnography Usefulness


Provides information on how effectively the
body is:

Producing CO2 (metabolism)

Transporting CO2 (perfusion)

Exhaling CO2 (ventilations)
Goal – attain/maintain CO2 levels 35 – 45 mmHg
9
Capnography Usefulness cont’d
10

Confirms and monitors advanced airway placement

Indicates effectiveness of chest compressions
 Blood
must circulate through lungs to off-load CO2 for it
to be exhaled
 Levels

expected to minimally be >10mmHg during CPR
Indicates return of spontaneous circulation (ROSC)
 Sudden,

sustained rise in levels toward 35-45 mmHg
Allows early interventions to be started
Capnography Usefulness cont’d
11

Monitor asthma & COPD conditions and response to
bronchodilator therapy

Detect increased respiratory depression and hypoventilation
 Tiring
accessory muscles
 Neuromuscular
disease effect on respiratory center
 Change
in level of consciousness – alcohol/drug overdose,
head trauma, sedation/analgesia
 Seizure
activity &/or post ictal period
Capnography Waveform

A-B – respiratory baseline

B-C expiratory upslope

C-D expiratory plateau

D – end of exhalation
 point

of measurement
D-E – inspiratory downslope
12
Capnography Waveforms

Hypoventilation
 CO2
retained so
values 

Hyperventilation
 CO2
eliminated
so values 
13
Capnography Waveforms

Asthma attack or COPD
 Difficulty
upslope
exhaling evidenced by slow, gradual
14
Capnography Waveforms

Apnea or loss of
advanced airway
- flat line
15
ETCO2 Detector

End tidal (end of breath) CO2 detector

Qualitative device
16
 Indicates
presence/absence of detectable CO2 exhaled
via pH sensitive paper
 Does
not provide specific measurement of numeric value
 Color
 Able
 May
scale estimates CO2 level
to change as detected levels change
take up to 6 breaths to wash enough CO2 out for
proper measurement
ETCO2 cont’d
17

Gastric content or acidic drug contact on pH
paper can affect accuracy of values detected

When perfusion decreased
(shock, arrest) ETCO2 reflects
change in pulmonary blood flow
CO2 level
 Does
not reflect ventilation status
and
Altered CO2 Levels

 CO2 level
 Shock,
cardiac arrest, pulmonary embolism,
bronchospasm, complete airway obstruction

 CO2 level
 Hypoventilation,
hyperthermia
respiratory depression,
18
CO2 Influence on Circulation

19
CO2 in blood (hypoventilation)
 Cerebral
vasodilation  increase in intracranial
pressure (ICP) due to increased blood flow to
the brain

CO2 in blood (hyperventilation)
 Cerebral
vasoconstriction  decrease in fresh
blood flow to brain; decrease in levels of
adequate oxygen and glucose negatively
affect function of brain
ETCO2 Result Interpretation

Yellow – yes, CO2 is being detected in exhaled
breath

Tan – poor perfusion or ventilation status
 First
evaluate placement of airway device
 Continue

to trouble shoot
Blue or purple – no CO2 being detected
 First
evaluate placement of airway device
 Continue
to trouble shoot
20
Trouble Shooting Advanced Airway
Placement – “DOPE”

D – displacement of tube (i.e.: into esophagus)
 Chest
rise and fall?
 Gastric
sounds?
 Bilateral
breath sounds?

O – obstruction

P – pneumothorax

E – equipment failure
 Faulty
cuff
21
Esophageal Detector Device - EDD
22

A modified bulb syringe

Simple means of evaluating for missed endotracheal
intubation

Squeeze bulb, attach to end of endotracheal tube

Bulb re-expands = tube in trachea

Bulb does not re-expand or does so slowly – collapsing
sides of esophagus onto tube preventing air from filling
EDD – consider esophageal placement
EDD cont’d
23

Need to interrupt ventilations to use device

Evaluate results of technique used with results of all other
steps of confirmation – could be extenuating reason why
you get false negatives
Defibrillators

Electrical capacitor that stores energy

Biphasic defibrillators provide waveforms that
use less DC energy than monophasic machines
 Energy
flows in one direction and then reverses

Therefore, possible decrease in tissue damage

Survival rates increase if early CPR provided with
prompt defibrillation attempt as soon as possible
after collapse
24
Defibrillation

Early defibrillation critical to survival from sudden
cardiac arrest
 Most
frequent initial rhythm in arrest is VF
 Treatment
for VF is defib (defibrillation)
 Probability
of successful defibrillation diminishes
over time
 VF

deteriorates to asystole over time
Check with your vendor to know your biphasic
device’s recommended energy settings
25
Ventricular Fibrillation as Presenting
Rhythm

Best chance of survival in public

Early activation of EMS
 CPR


initiated very soon after collapse
Early application of AED or other defibrillation attempt
Current passes though fibrillating heart to depolarize
heart cells to allow them to uniformly repolarize
 Allows
dominant pacemaker (SA node) to take over
electrical control
 Goal
– resume organized electrical activity
26
Influences on Success of Defibrillation

Time from onset of VF – shorter time  survival

Condition of myocardium
 Less
success in presence of hypoxia, acidosis,
hypothermia, electrolyte imbalance, drug toxicity

Pad size
 Larger
pads felt to be more effective and cause
less myocardial damage; should not overlap
 Ideal
size for adults10-13 cm (4 -5 inches)
 Ideal
size for peds 4.5 cm (roughly 3 inches)
27
Influences cont’d

Pad / skin interface
 Need
to  the resistance
 Greater
the resistance the less energy delivered to
the heart and the greater the heat production at
the skin surface

Pad contact
 Max
contact with skin; no air bubbles breaking
contact; no pads touching or overlapping

Avoiding placement of pads over bone
 Bone
is poor conductor of electricity
28
Pad Placement
Operator Choice

Anterior /posterior
1
pad over apex of heart, under
left breast
1
pad under left scapula in line
with anterior pad

Anterior/anterior (apex)
 Anterior
pad on right upper sternum just
below clavicle
 Apex
pad below left nipple in anterior axillary line over
apex of heart
29
Pad Placement cont’d

DO NOT place pads
 Over
sternum – bone poor conductor of
electricity
 Over
pacemaker or AICD – deflects energy;
could damage the implanted device
 Place
 Over
at least one inch away from device
topical medication patches – deflects
energy
30
Defibrillation

Indications
 VF,

pulseless VT
Contraindications
 Failure
to demonstrate one of the above rhythms
 Asystole
– defibrillation places a patient into
asystole for the dominant pacemaker to take
over
 PEA
– electrical activity not a problem; needs
mechanical response fixed
31
Defibrillation

Equipment
 Monitor/defibrillator
 Defibrillating
 Example:
pads
PadPro
 Defibrillation/pacing/cardioversion/monitoring
electrodes
 Most
come with conductive gel already applied in
center of pad
32
Defibrillation Safety

CPR is performed just until the defibrillator is ready

Confirm O2 not blowing across patient’s chest wall –
hold away from the patient when not using the BVM

Physically look all around (“nose to toes”)

Clearly yell out “all clear”

Deliver energy

Immediately resume CPR
33
Return of Spontaneous Circulation
ROSC

After 2 minutes of resumed CPR, evaluate the
rhythm

If an organized rhythm is viewed on the monitor,
THEN check for a pulse
 If
no pulse, rhythm is PEA
 Resume
CPR
 Adult
1 and 2 man CPR 30:2
 Infant
and child 1 man CPR 30:2
 Infant
and child 2 man CPR 15:2
34
Indications to Activate Cooling
Protocol Post ROSC

Presumed cardiac arrest
 NOT
indicated for respiratory or traumatic arrest

Remains unconscious and unresponsive

ROSC present at least 5 minutes

Systolic B/P >90 with or without pressor agent use
(i.e.: Dopamine)

Airway has been secured
35
ROSC Contraindications

Major head trauma or traumatic arrest

Recent major surgery within past 14 days

Systemic infection (i.e.: septic shock)

Coma from other causes

Active bleeding

Isolated respiratory arrest

Hypothermia (34o C/93.2o F) already present
36
Induction of ROSC

Place ice paks in the axilla, neck and groin
 Areas
where blood vessels tend to be superficial

Place ice pak over IV site

If patient begins to shiver, contact Medical
Control
 Anticipate
 Shivering
order for Valium to stop the shivering
will generate heat and therefore
increase body temperature
37
Vasopressor - Dopamine

Stimulates alpha, beta, and dopaminergic
receptors based on dose provided

Starting dose 5mcg/kg/min IVPB up to 20
mcg/kg/min

Take patient’s weight and drop last number
 Minus
 Left
 Ex:
2 from number left
with rate to run IVPB in drops per minute
150 pounds; drop “0”
 15
– 2 = 13 drops per minute
38
Dopamine cont’d


Dopaminergic effects at 2 mcg/kg/min
 Renal
vasodilation to improve blood flow to kidneys
 Keep
kidneys working, the body keeps working
Beta effects 5 – 10 mcg/kg/min
 Increases
strength of myocardial contraction –
squeeze more blood out of ventricles

Alpha effects at >20 mcg/kg/min
 Severe
vasoconstriction that diminishes blood flow to
all tissues
39
AED (Automated External Defibrillator) 40
Function

AED’s will

Analyze rhythms

Deliver a shock if indicated
 Ventricular
fibrillation (VF)
 Monomorphic
and polymorphic VT if rate and R
wave morphology exceed preset values

Will not deliver a synchronized shock

Can indicate loose electrodes / poor electrode
contact
AED Use in Pediatrics
41

Pediatric attenuator used to deliver lower energy doses to
children (built into cables with peds pads)

1-8 year old


Use pediatric pads if available

No attenuator (peds pads)available, use standard AED pads
< 1 year old

Manual defibrillator preferred

If no manual defibrillator, use peds pads with attenuator

No peds pads, use AED pads available
AED Use With CPR

Do NOT interrupt CPR to apply pads
 Apply
pads while CPR in progress

Do not touch patient during analysis phase

Can provide compressions during charging phase

No O2 flow across patient body during defibrillation
attempt

Call and look “ALL CLEAR” prior to each defibrillation
attempt

Immediately resume CPR
42
Transition From AED To Defibrillator
43
 Upon
arrival at scene, if AED ready to discharge,
utilize AED
 Do
not interrupt operation of device
 During
2 minutes of CPR, can switch from AED use
to monitor/defibrillator
 Immediately
resume CPR after delivery of each
defibrillation attempt regardless of equipment used
Synchronized Cardioversion
44

A controlled form of defibrillation using a lower energy
level that interrupts underlying reentrant pathway

Used with organized rhythms and in presence of a pulse

Monitor interprets QRS cycle and energy delivered
during R wave
 Less
vulnerable area of QRS
 Downslope
 Minimal
of T wave is relative refractory area
stimulant could generate rhythm into VF
Indications Synchronized Cardioversion

Unstable tachyarrhythmias
 SVT
 Rapid
atrial fibrillation or flutter
 Hazard
of breaking loose a blood clot in the atria
and resulting in a stroke
 Ventricular
tachycardia
Note: polymorphic VT NOT likely to respond to
synchronized cardioversion – no defined R wave
45
Synchronized Cardioversion Procedure

Apply pads
 Anterior/anterior

or anterior/posterior position
Sedate if possible
 This
is a painful procedure!
 Versed
2 mg IVP/IO; repeated every 2 minutes;
max 10 mg (desired effect – sedation!)

Consider pain management
 Fentanyl
1 mcg/kg IVP/IN/IO; may repeat in 5
minutes to max of 200 mcg total dose
46
Sync Procedure cont’d

Activate “sync” button
 Verify

47
R wave is being flagged/identified
Choose energy setting starting at the lowest watt setting
 100j,
200j, 300j, 360j

Verify O2 not blowing across chest wall

Look (nose to toes) and call “ALL CLEAR”

Press and hold sync buttons until energy discharged
 Momentary
delay waiting to identify the R wave
Sync Procedure cont’d

If synchronized cardioversion needs to be
repeated, need to reset the “sync” button
 Safety
that machine will default to defibrillation
mode after every discharge of energy

If VF occurs, verify sync mode is off and defibrillate
patient without delay
48
Transcutaneous Pacemaker - TCP

Electrical cardiac pacing across the skin

TCP is a painful non-invasive procedure so sedation
will most likely be necessary

Indications
 Symptomatic
bradycardia
 Hypotensive
 Hypoperfusing
 Evaluate
level of consciousness and B/P for most
reliable indicators of patient condition/stability
49
TCP Procedure

Apply pads
 (-)
 (+)
over apex of heart, anterior chest wall
mid upper back below left scapula

Set desired heart rate (80)

Confirm sensitivity at auto/demand

Begin mA current at 0

Turn pacer on
50
TCP Procedure
cont’d

Slowly increase output until ventricular capture
 Spike
followed by widened QRS

Reassess vital signs and pain level

Document settings – mA and rate

Reassess need for sedation and analgesia
 Valium
2 mg IVP/IO over 2 minutes; repeat every
2 minutes until max of 10 mg total dose
 Fentanyl
1 mcg/kg IVP/IO/IN ; can repeat dose in
5 minutes with max total of 200 mcg
51
Critical Thinking Skill and TCP

In setting of acute MI, consider contacting
Medical Control
 May
want to decrease heart rate of TCP just
enough to maintain perfusion

Want to avoid increasing the work load on the
heart by automatically selecting 80 as the heart
rate
 Increasing
work load on heart may increase the
size of the infarction
52
What would you do…
53

You applied the TCP for a symptomatic bradycardia

You had a paced rhythm

You notice the following rhythm strip change – what is the
rhythm and what would you do?
Failure to capture

Reassess patient; increase mA; consider need for CPR
Defibrillation During Pacing Mode

Check your device for specifics

When in the pacing mode and the need to
defibrillate occurs, for some models, you may
have to turn off the pacing mode

If pacing must be resumed, reset all levels
54
12 Lead EKG’s
55

A graphic recording of electrical activity in the heart

Must evaluate the pulse to determine mechanical
response

Single lead (i.e.: lead II) evaluates cardiac rhythms

12 lead views can diagnose an acute MI

Early interpretation of 12 lead EKG  early diagnosing
 early reperfusion & restoring blood flow to ischemic
tissues
Acute MI

Death of portion of heart muscle from
prolonged deprivation of oxygenated blood

Heart’s demand exceeds supply of oxygen over
extended period of time

Often associated with atherosclerosis process

Location and size of infarct depends on vessel
involved and site of obstruction
 Left
ventricle most common site
56
Evolution of Acute MI

Ischemia – initial lack of oxygen
 ST

Injury to myocardial tissue
 ST

depression can be reversible
elevation can be reversible
Death/infarction
 Necrotic
tissue can lead to scar formation
 Irreversible
 Can
process
leave a positive Q wave marker in leads
affected
57
58
AMI Process

Ring of ischemic tissue surrounds infarcted
myocardium

Collateral circulation may develop

Ischemic area often site of arrhythmia
development
59
Complications of AMI

60
Arrhythmia most common

VF most lethal
 Most
common cause of sudden death within one hour of
onset of signs and symptoms

Destruction of myocardial muscle mass can lead to CHF
due to impairment of pumping capability

Cardiogenic shock may develop if heart function is
inefficient and inadequate

Ventricular aneurysm can develop due to damaged
wall of heart – can rupture causing instant death
Patient Assessment

Pain most common chief complaint
 Lasts
 Not
more than 30 minutes
relieved by rest or NTG

Tired and weak most often complaint in elderly,
long standing diabetic and women

Determine responses to OPQRST assessment
 Activity
at onset, provocation/palliation
(worsens/improves), quality in their words,
radiation, severity on 0 -10 scale, time of onset
61
EMS Action

Apply monitor

Examine underlying rhythm – document rhythm

Obtain 12 lead EKG
 Evaluate

for ST segment elevation
 If
elevation, in what group of leads?
 If
depressed, look for reciprocal elevation
Watch for development of arrhythmias
62
Proper Placement EKG Chest Leads
63
Groups of Acute MI by Leads
64
Identifying Groups of ST Elevation
65
Why Aspirin???
66

Inhibits platelets from aggregating/collecting at site of
plaque rupture inside vessel wall

Decreases morbidity and mortality rate

Chewed to increase breakdown and absorption time of
medication

Patients on daily aspirin already have elevated and
acceptable blood levels of aspirin – don’t have to
supplement a dose if absolutely sure they took one today

Always better to give full dose than to risk skipping any
dose (just in case of skipped dose)
12 Lead EKG Procedure

Obtain rhythm strip

Interpret, report and document rhythm

Obtain 12 lead EKG
 Identified
with patient age, sex, department
name in preparation for transmission

Review for ST elevation pattern

Report to Medical Control what you see, then
read word for word interpretation on 12 lead
EKG printout
67
12 Lead EKG Documentation

Interpret the rhythm strip and document on
patient care run report

Document presence or absence of ST elevation
 If

elevation, report and document in which leads
Provide copy of rhythm strip and 12 lead EKG to
ED secretary for placement on patient’s medical
record
68
CPAP

Continuous positive airway pressure

Effective therapy for acute CHF –
pulmonary edema

Can avert the need for intubation and
mechanical ventilation if applied early enough

Maintains constant pressure within the airway
and through-out the respiratory cycle

Keeps alveoli open and expanded

Increases surface space for diffusion of gases
69
CPAP cont’d
 Buys
time for other therapies
(i.e.: medications) to work
 Precaution
 Too
much pressure can
inhibit ventricular filling
decreasing cardiac output
 B/P
can drop
70
CPAP Indications

Stable pulmonary edema
 Alert;

systolic B/P >90mmHg
COPD with wheezing
 First
contact Medical Control for orders

For unstable pulmonary edema (altered mental
status, systolic B/P <90 mmHg), contact Medical
Control to discuss use of CPAP

Reminder: all therapies used in pulmonary
edema have potential to drop the B/P
71
CPAP Contraindications

Respiratory arrest or apnea

Pneumothorax or trauma to chest wall

Tracheostomy present
 Can’t

get tight fit over trach stoma
Actively vomiting
72
CPAP Procedure

Sit patient upright

Assess and obtain baseline vital signs

Begin O2 via non-rebreather mask while setting
up equipment

Administer first dose NTG
 Used
as venodilator to decrease blood return to
heart (decreases pre-load)
73
CPAP Flow Safe II Procedure

Assemble CPAP Flow Safe II
 Attach
proximal end of O2 tubing with
manometer to port in mask
 Attach
distal end of tubing to O2 source
 Secure
face mask snugly to patient’s face using
head harness
 Adjust

O2 flow – 13-14 lpm for 10 cm H2O
Continue administration of medications
74
CPAP Procedure cont’d
75

Lasix 40 mg IVP (80mg if on med at home) as a diuretic

If systolic B/P remains >90 mmHg
 Morphine
2 mg IVP slowly over 2 minutes
 May
repeat 2 mg every 2 minutes as needed to max of
10 mg
 Used

to decrease anxiety and for benefit of vasodilation
If patient shows deterioration during CPAP treatment,
remove CPAP, consider intubation, inform Medical
Control
CPAP Tidbits

Be prepared to coach patient through first few
minutes of CPAP use until positive effects begin
 Patient
is already frightened
 Patient
may feel suffocated with the mask on
 Exhaling
against the resistance is tough at first

76
HARE and Saeger Traction


Indicated for isolated mid-femur fractures
 Reduces
muscle spasm and therefore pain level
 Reduces
risk of bones overriding
Contraindications
 Open
 Do
 Hip,
fracture
not want to draw contamination into the wound
knee, or pelvic fractures
 Increased
risk of nervous or vascular complications
77
Preparing for Traction Application

Assess motor/sensory/circulation before and
after splinting
 Can
you move this/can you feel that?
 Mark
pulses once found – easier to find the site on
reassessment
 Compare

to uninjured side
Apply manual traction until mechanical traction
in place
78
HARE Application

Measure and adjust splint

Support distal end of splint on backboard

Apply distal ankle hitch while maintaining
manual traction

Position traction under injured extremity

Secure proximal end to groin area

Apply hook to ankle hitch

Replace manual traction with mechanical traction
79
HARE Traction

80
Adjust straps avoiding over the knee and over the injured site
Saeger Traction Application

Support leg and maintain gentle traction

Use uninjured leg to measure and adjust splint length

Place splint inside injure leg; padded bar snug against
pelvis in groin (watch pressure areas!!!)

Attach strap to thigh

Attach padded hitch to foot and ankle

Extend splint until correct tension obtained

Apply elastic straps to secure leg to splint
81
Saeger Splint

Do not place straps over fracture
site

Release manual
traction

Reassess distal pulse,
motor, and sensory
82
Pain Control With Use of Traction

Fentanyl 1 mcg/kg IVP/IN/IO
 May
repeat same dose in 5 minutes
 Max
total dose of 200 mcg

As a CNS depressant, watch the respiratory status

If respiratory depression occurs, begin to support
ventilations via BVM
1
Breath every 5 – 6 seconds
 Document

10 -12 breaths per minute assisted
Narcan 2 mg IVP/IN/IO can be used to reverse
respiratory depression due to opioid use
83
Cleaning of Traction Splints

Rinse off gross contaminant

Wet down all surfaces with Cavicide wipes

Let device air dry

Confirm all straps are accounted for and
repackage device in preparation for next
patient
84
Combat Application Tourniquet CAT

Indications
 Uncontrollable
hemorrhage when
usual means have failed

Contraindications
 Non-compressable

site
Equipment
 Tourniquet
with attached rod
85
CAT - Procedure

Apply tourniquet proximal to bleeding site as
distal as possible; preferably over bare skin

Pull band very tight and securely fasten band
back on itself

Twist rod until bright red bleeding has stopped
 Or
until distal pulses are eliminated

Place rod inside clip; locking into place

Secure straps over clip holding rod
86
CAT – Potential Problems

Inability to control bleeding
 Continue
 Prepare
 Apply
with direct pressure
to apply a second CAT
QuikClot dressing if available
 Must
be applied directly over wound site for
impregnated material to be effective
87
CAT – Documentation Pearls

Reason CAT was applied

Time and site of CAT application

Results post intervention

Consideration of administration of pain medication
 Fentanyl
1 mcg/kg IVP/IN/IO
 May
repeat in 5 minutes, same dose
 Max
200 mcg total dosing
88
Midazolam 

Versed
Potent, rapid onset, short acting benzodiazepine
 Onset
3-5 minutes
 Duration
20-30 minutes

Used as sedative and hypnotic

Has amnesic properties and reduces anxiety
 Amnesia
of recent past (antegrade) useful to
inhibit unpleasant reminders of procedures

Low toxicity and high rate of effectiveness
89
Indications for

Versed Per
Region X SOP’s

Sedation prior to synchronized cardioversion

Useful to maintain sedation post drug assisted
intubation procedure

Suppresses seizure activity
 IN

90
route allows safer delivery method
Decreases severe anxiety and apprehension
Precautions With

Versed

Crosses placental barrier – could cause
respiratory depression in newly born infant

Elderly more sensitive to effects; metabolize med
more slowly

Toxicity increases when mixed with CNS
depressants (alcohol, opioids like Fentanyl,
tricyclic antidepressants)

Toxicity may be higher in patients with COPD
91
Side Effects of

Versed

Respiratory depression

Drowsiness

Hypotension

When administering, have a BVM readily available

Be prepared to assist respirations
1
breath every 5 – 6 seconds
 Document
10 – 12 breaths per minute assisted
92
Fentanyl

Synthetic opiate analgesic for pain control

Shorter acting than morphine

Onset immediate when administered IVP

Peak effect 3 5 minutes

Lasts 30 – 60 minutes

Does not affect blood pressure like Morphine
does
93
Dosing For Fentanyl per Region X SOP’s

Adult
1

mcg/kg IN/IVP/IO
 May
repeat same dose in 5 minutes
 Max
total dose 200 mcg
Pediatrics
 0.5
mcg/kg IVP/IN/IO
 May
repeat same dose in 5 minutes
 Max
total dose 200 mcg
94
Precautions With Fentanyl

Crosses the placental barrier – could cause
respiratory depression in newly born infant

Monitor respiratory rate, SpO2 levels, and level of
consciousness

Have BVM available to counteract potential
respiratory depression
1
breath every 5 – 6 seconds
 Document
10 – 12 respirations per minute
95
Cleaning of Equipment –
After Every Patient Use
96

In general, each piece of equipment in contact with a
patient MUST be cleaned between each patient use

Gross contaminant must be removed

Surfaces need to remain wet and allowed to air dry

All cables need to be wiped down (i.e.: EKG, B/P, pulse ox)
 Cables
drag across contaminated surfaces A LOT!!!

B/P cuffs need to be wiped down

Pulse ox sensors need to be cleaned following manufacturer
recommendations
Department Review of Equipment

Review set up of capnography monitoring

Review operation of monitor/defibrillator for
defibrillation, synchronized cardioversion, and
TCP

Review procedures for transmission of 12 lead
EKG to receiving hospital

In teams, apply the HARE or Saeger traction
device to a peer
97
Bibliography
98

Bledsoe, B., Porter, R., Cherry, R. Paramedic Care Principles &
Practices, 4th edition. Brady. 2013.

Campbell, J., International Trauma Life Support for Emergency
Care Providers. 7th Edition. Pearson. 2012.

McDonald, J. ALS Skills Review. AAOS. Jones and Bartlett. 2009.

Mistovich, J., Karren, K. Prehospital Emergency Care 9th Edition.
Brady. 2010.

Pediatric Education for Prehospital Professionals 3rd Edition.
American Academy of Pediatrics. 2014.

Region X SOP’s; IDPH Approved January 6, 2012.

www.MARescue.com