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June 2009 CE

Site code # 107200E-1209

Region X SOP Review ACS, Asystole/PEA, Bradycardia,

VF/Pulseless VT, Conscious Sedation, Region X Field Triage

Criteria

Prepared by: Sharon Hopkins, RN, BSN, EMT-P

To view on the website visit:

www.condell.org/emsce/

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Date of CE presentation: June, 2009 Topic: Region x SOP Review: ACS, Asystole/PEA, Bradycardia, VF/Pulseless VT, Conscious Sedation, Region X field Triage Criteria Behavioral Objectives: Upon successful completion of this module, the EMS provider will be able to: 1. Identify the location for V1 – V6 electrodes (6 chest electrodes) to obtain a 12 lead EKG. 2. Identify ST elevation when presented with a 12 lead EKG. 3. Identify when Aspirin should be administered for an acute coronary syndrome patient. 4. Identify when Nitroglycerin should be administered for an acute coronary syndrome patient. 5. Identify when Morphine should be administered for an acute coronary syndrome patient. 6. Identify the Region X SOP criteria for treating asystole. 7. Identify the Region X SOP criteria for treating PEA. 8. List the 6 H’s and 5 T’s that could be causative reasons for cardiac arrest. 9. Identify second degree heat block Type I (Wenckebach), Type II (classical, and third degree (complete). 10. Identify the Region X SOP criteria for treating stable bradycardia. 11. Identify the Region X SOP criteria for treating unstable bradycardia. 12. Identify placement of pads for transcutaneous pacing. 13. Identify the Region X SOP for treatment of ventricular fibrillation and pulseless ventricular tachycardia. 14. Identify the indications and dosing for Lidocaine in the Region X SOP for Conscious Sedation. 15. Identify the indications and dosing for Versed in the Region X SOP for Conscious Sedation. 16. Identify the indications and dosing for Morphine in the Region X SOP for Conscious Sedation. 17. Identify the indications and dosing for Benzocaine in the Region X SOP for Conscious Sedation. 18. Identify the criteria for a Category I trauma patient. 19. Identify transport decisions for a Category I trauma patient. 20. Identify the criteria for a Category II trauma patient. 21. Identify transport decisions for a Category II trauma patient. 22. Actively participate in scenario practice for critical cardiac events. 23. Given a picture, identify ST elevation. References: 1. Aehlert, B. ECG’s Made Easy. 3rd Edition. Elsevier. 2006. 2. CMC EMS System February 2009 CE. 12 Lead EKG’s. 3. Region X SOP’s March 2007, Amended January 1, 2008 4. www.ambulancetechnicianstudy.co.uk 5. www.davidge2.umaryland.edu/~emig/gif/pared2.gif 6. www.emedu.org/ecg/images/ami2b_ia.jpg File: CE, EMS; CE Packets; 2009; June 2009 SOP Review Dept Obj & Ref

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12 lead 12 lead

EKG EKG

Chest Chest

LeadsLeads

Placement Placement starts in starts in the 4the 4thth

ICS to ICS to the right the right of the of the sternumsternum

Groups of anatomical Regions on Groups of anatomical Regions on

EKG EKG –– Contiguous LeadsContiguous Leads

�� Lateral wall Lateral wall –– I, aVL, V5, V6I, aVL, V5, V6

�� Inferior wall Inferior wall –– II, II, aVFII, II, aVF

�� Septal wall Septal wall –– V1 and V2V1 and V2

�� Anterior wall Anterior wall –– V3 and V4V3 and V4

ST Elevation ST Elevation

��MeasurementMeasurement

–– Look 0.04 seconds after the J point Look 0.04 seconds after the J point

��J point is where the QRS complex and ST J point is where the QRS complex and ST

segment meetsegment meet

–– ST elevation significant if:ST elevation significant if:

��> 1 mm (one small box) above the baseline > 1 mm (one small box) above the baseline

is noted in 2 or more leads looking at the is noted in 2 or more leads looking at the

same anatomical region (contiguous leads)same anatomical region (contiguous leads)

��> 1mm in 2 or more anatomically > 1mm in 2 or more anatomically

contiguous chest leadscontiguous chest leads

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Where is the ST elevation?Where is the ST elevation?

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Where is the ST elevation?Where is the ST elevation?

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Where is the ST elevation?Where is the ST elevation?

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Where is the ST elevation?Where is the ST elevation?

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Differentiating Heart Blocks Slide 49

There are more P waves

than QRS’s

Is ventricular

rhythm regular?

Are PR intervals

constant on beats that

conduct

Do PR intervals get

progressively longer

until a QRS is dropped?

Are PR intervals

variable lengths,

with no pattern? Mobitz

Type II

- Classical

Mobitz Type I

- Wenckebach 3rd degree

- Complete

Heart block

YES

YES

NO NO

YES YES

NO

NO

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Slide 55

Slide 61

SCENARIO #1

There is no pulse

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SCENARIO #2 The patient has lost consciousness and now has no pulse

SCENARIO #2 RHYTHM CHANGE

SCENARIO #2 RHYTHM CHANGE

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SCEANRIO #3

SCENARIO #4

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SCENARIO #5

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Pre-Quiz

Paramedic Level

For June 2009 CE Material SOP Review

Name_________________________________Date___________ 1. You are on the scene for a patient who complains of chest pain. You are following the Acute Coronary Syndrome protocol. The patient states they took an Aspirin today. What do you do regarding your dose of Aspirin? 2. What should you assess before and after administering nitroglycerin to any patient and why? 3. What side effects should you warn/advise the patient they are most likely to experience after being given a nitroglycerin? 4. What complication is most likely if the patient with ST elevation in II, III, avF (inferior wall MI) is given nitroglycerin? 5. Identify this rhythm strip: ________________________

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6. Identify this rhythm strip: ______________________

7. Why is Lidocaine given in conscious sedation and how much? 8. When do you use Amiodarone and when do you use Lidocaine in VF/Pulseless VT? 9. Identify at least 3 criteria for a Category I trauma patient. 10. Identify at least 3 criteria for a Category II trauma patient. File: CE, EMS; CE Packets; 2009; June 2009 Sop Review Pre-quiz