Paramedic Care Principles Practice, V2, 5e Bledsoe SM Completed with Answers

Paramedic Care Principles Practice, V2, 5e Bledsoe SM Completed with Answers Paramedic CarePrinciples _ Practice, V2, 5e Bledsoe SM©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 1 Detailed Lesson Plan Chapter 1 Scene Size-Up 80–85 Minutes Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 I. Case Study Teaching Tips Have a student read the scenario. Tell students the case will be reviewed after the lecture. 5 II. Introduction A. Scene size-up is the essential first step of every emergency call B. Critical decisions about the scene are made as the scene reveals itself C. Safety is the MOST important factor of any EMS call D. Components of scene size-up include: 1. Standard Precautions 2. Scene safety 3. Resource determination 4. Location of patients 5. Mechanism of injury/nature of illness Teaching Tips Remember that an injured medic is a hindrance, and a dead medic is useless. 15 III. Standard Precautions A. Strategy designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection B. Standard Precautions dictate that all EMS personnel take the same (standard) precautions with every patient C. Personal protection equipment (PPE) includes: 1. Hand hygiene (antimicrobial waterless soap) 2. Protective gloves 3. Masks and protective eyewear 4. HEPA and N-95 respirators 5. Gowns 6. Disposable resuscitation equipment Class Activities This can get messy, suggested only if people are wearing old clothing. Using a needleless syringe, spray student or yourself with colored water while wearing particular PPE. Remove the PPE and do it again; very good visual on how important PPE really is. MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Critical Thinking Questions  Class Activities©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 2 Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes D. All contaminated items disposed of in appropriate biohazard bags E. Handwashing remains the most important infection control practice 15 IV. Scene Safety A. Make sure that your scene is safe for yourself, crew, other personnel, patient, and bystanders B. There is no obligation for you to enter a scene that is unsafe C. Your personal safety is the top priority at any emergency scene D. Factors that can make a scene unsafe include: 1. Environmental hazards 2. Extreme weather conditions (rain, snow, ice, extreme heat/cold) 3. Terrain (flat, rocky, etc.) 4. Water (standing or rushing) 5. Electricity (must be turned off before proceeding) 6. Confined space (only properly trained individuals can enter) 7. Hazardous materials (chemical, biological, radiologic, nuclear, and explosive agents) 8. Violence (angry crowds, weapons, threatening behaviors) 9. Roadway rescue operations (motor vehicle collision on a major roadway, traffic flow) Class Activities Have students use mock scenarios to list possible scene hazards, along with resources that would be needed to control the scene. Critical Thinking Questions Using mock scenarios ask students when they would, and when they would not, feel comfortable entering a situation and why. 5 V. Resource Determination A. This is a critical phase that needs to be done as soon as possible, to save critical minutes B. The resources that are needed are dictated by the scene (police, fire, hazmat, power company, heavy rescue, etc.) C. All responding personnel must have appropriate and adequate equipment D. Safe, orderly, and controlled incident management is essential for everyone’s safety Class Activities With students, compile a list of resources that might be needed on an EMS scene. 5 VI. Location of Patients A. Search the area to locate all patients B. If you have more patients then you can manage, call for assistance early C. Incident management may be implemented for multiple-patient incident calls Discussion Topics Discuss with students scenarios they might encounter in which the number of patients might be unknown and clues they may observe that indicate number of patients (car seats, toys, diaper bag, etc.).©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 3 Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 15 VII. Mechanism of Injury/Nature of Illness A. Mechanism of Injury 1. The strength, direction, and nature of forces that injured the patient 2. Mechanisms of injury found in automobile accidents, gunshot wounds, pedestrian struck by auto, falls, etc. can cause serious internal injury 3. Most trauma injuries have an index of suspicion, which allows a prediction of injuries based on the mechanism of injury B. Nature of Illness 1. The medical complaint that can be determined by patient, family, and bystanders 2. Look at clues found on scene: pill bottles, medical care equipment, drug paraphernalia, patient complaint, and position of patient to identify 3. Nature of illness may be different from chief complaint Teaching Tips Stress to student how a MOI or NOI can dictate a call, and how both can cause tunnel vision if a proper exam is not completed. Class Activities As a group, have students list possible predictable injuries from auto accidents, gunshot wound, etc. Ask them to list what injuries they would expect to see. 5 VIII.Summary A. Scene size-up is the initial step in the patient care process B. Begins at dispatch and ends once you are clear of the call C. Scene size-up will become second nature to you D. Always make it a point to pause and consciously look around the scene before proceeding into any situation. E. Keep yourself and your crew safe, and ensure necessary resources are focused on patient care and outcomes 5 IX. Case Study Class Activities Discuss the case with students now that they are familiar with the chapter. 5 X. You Make the Call Class Activities Read and discuss the call and questions as a group.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 4 Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 XI. Review Questions Class Activities Pass out review questions before the lesson starts. Have students answer them. Then go over the questions again after the lecture to assess students’ understanding of the information.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 1 Detailed Lesson Plan Chapter 2 Primary Assessment 100–105 Minutes Chapter 2 objectives can be found on text p. 20. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 I. Case Study Teaching Tips Have a student read the scenario. Tell students the case will be reviewed after the lecture. 5 II. Introduction A. Primary assessment is the basis of all prehospital emergency care B. Steps of the primary assessment include: 1. Form a general impression 2. Stabilize cervical spine as needed 3. Assess baseline mental status 4. Assess and manage airway 5. Assess and manage breathing 6. Assess and manage circulation 7. Determine priorities Discussion Topics With students, discuss what would happen if the paramedic skipped over the primary assessment. Points to Emphasize Explain to students why the entire primary assessment should take less than 1 minute, unless lifesaving measures need to be taken. 5 III. Forming a General Impression A. Involves your first intuitive evaluation of your patient B. The general impression is based on environmental information, MOI or NOI, the patient’s posture and overall look, the chief complaint, and your instincts C. Standard Precautions, consent, and cervical stabilization are included in this stage of assessment Class Activities Have a few students act as patients with varying medical and traumatic complaints. Students acting as paramedics can practice forming general impressions and initiating care. 10 IV. Mental Status Assessment A. Crucial component for every patient B. AVPU levels used to determine mental status 1. A = Alert (awake and alert) Discussion Topics Discuss with students different stimuli that are used to determine AVPU. MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Class Activities  Points to Emphasize  Knowledge Application©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 2 Chapter 2 objectives can be found on text p. 20. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 2. V = Verbal Response (responds to verbal stimuli) 3. P = Painful Response (responds to painful stimuli) a.Decorticate – arms flexed, legs extended b.Decerebate – arms and legs extended 4. U = Unresponsive (comatose and fails to respond to any noxious stimuli) 15 V. Airway Assessment A. Open the airway with head-tilt/chin-lift or jaw thrust maneuver B. Infants and young children: may be necessary to move the child’s head through a range of positions C. Remember that normal breathing is quiet with free air movement D. Look for chest rise E. A noisy airway is a partially obstructed airway 1. Snoring (partially blocked upper airway, usually the tongue) a. Reposition the head and neck 2. Gurgling (fluid blocking upper airway) a. Suction 3. Stridor (life-threatening upper airway obstruction) a.Look for foreign body, severe swelling, allergic reaction, infection and treat the airway accordingly 4. Wheezing (constricted bronchioles of lower airways) a.Asthma, bronchitis, emphysema, acute pulmonary edema, and bronchiolitis b.Treat with bronchodilator medications 5. No air movement (respiratory arrest) a.Provide ventilation with BVM and high-concentration oxygen F. Use airway adjuncts such as oropharyngeal or nasopharyngeal to maintain the airway G. Advanced airways include intubation, multilumen airways, needle, or surgical cricothyroidotomy H. Hypoxic patients require oxygen delivery via a nonrebreather mask Teaching Tips If a patient’s airway sounds inadequate, you need to find the cause immediately. Find a lung sounds CD that students can listen to, so they can become familiar with abnormal airway sounds. Class Activities Pull out the airway equipment and allow students to view all of it as you explain the indications and contraindications of each piece.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 3 Chapter 2 objectives can be found on text p. 20. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 15 VI. Breathing Assessment A. Assessment for adequate breathing includes looking at: 1. Respiratory rate and quality 2. Respiratory pattern B. Signs of inadequate breathing include: 1. Altered mental status, confusion, apprehension, and agitation 2. Shortness of breath while speaking 3. Retractions 4. Asymmetric chest wall movement 5. Accessory muscle use 6. Cyanosis 7. Audible sounds 8. Abnormally rapid, slow, or shallow breathing 9. Nasal flaring C. If your patient presents with inadequate breathing, immediately assess the patient’s neck and chest, looking for injuries and listening to lung sounds D. Treat the life-threatening breathing problems as you find them (sucking chest wound, tension pneumothorax, etc.) E. Noninvasive devices for assessing adequacy of breathing: pulse oximeter and capnography monitor Discussion Topics Discuss with students the different breathing patterns, including agonal, Cheyne-Stokes, Biot’s, hyperventilation, tachypnea, bradypnea, etc. 15 VII. Circulation Assessment A. The evaluation of the pulse and skin of the patient, as well as controlling any hemorrhage B. If radial pulse is absent, check for carotid pulse C. Assess the pulse for rate and quality 1. Very fast and very slow rates may indicate life-threatening cardiac dysrhythmias and can result in decreased cardiac output 2. Quality of the pulse can indicate cardiac arrhythmias, poor perfusion, head injuries, hypertension, heat stroke, etc. D. Stop any major external bleeding 1. Direct pressure, elevation, tourniquets, and hemostatic agents (HemCon, QuikClot, Celox) E. Assess the skin for temperature, moisture, and color 1. Mottled, cyanotic, pale or ashen, clammy, and cool can indicate poor Class Activities Have students find the various pulses on each other.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 4 Chapter 2 objectives can be found on text p. 20. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes perfusion 2. Capillary refill is a reliable indicator of circulatory function in infants and young children when assessing perfusion 15 VIII. Priority Determination A. Priority is determined once a primary assessment is completed B. Identify other life-threatening injuries or illnesses by performing a rapid head-to-toe assessment C. Four-step process for identifying priority patients: 1. Vital signs and level of consciousness: GCS < 14, systolic < 90, and respiratory rate < 10 or > 29 = transport to highest level trauma center 2. Injuries: penetrating trauma to head, neck, torso, or extremities proximal to elbow or knee, chest wall instability or deformity, two or more proximal long bone fractures, crushed, degloved, or mangled extremity or pulseless extremity, amputation proximal to wrist or ankle, pelvic fracture, open or depressed skull fracture, paralysis = transport to highest level trauma center 3. Mechanism of injury: fall > 20 feet for adult and > 10 feet for child, high-risk auto crash (intrusion, ejection, death of occupant, significant impact, auto-versus-pedestrian, motorcycle crash > 20 mph = transport to closest appropriate trauma facility) 4. Miscellaneous findings: age > 55, children, anticoagulation or bleeding disorders, burns, pregnancy > 20 weeks = contact medical control and consider transport to trauma center or specific resource hospital Class Activities As a group, give students scenarios and have them decide the priority of a patient based on the four-step process. Knowledge Application Have students complete a documentation of care that lists the primary assessment and what care they provided. Provide them with various scenarios and have them write their responses on index cards. 5 IX. Summary A. A primary assessment is the crucial first stage in providing lifesaving measures to seriously ill or injured patients. B. Completing a primary assessment on every patient allows for a systematic approach to identify and correct any life threats in airway, breathing, circulation, and mental status.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 5 Chapter 2 objectives can be found on text p. 20. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 X. Case Study Class Activities Discuss the case with students now that they are familiar with the chapter. 5 XI. You Make the Call Class Activities Read and discuss the call and questions as a group. 5 XII. Review Questions Class Activities Pass out review questions before the lesson starts. Have students answer them. Then go over the questions again after the lecture to assess students’ understanding of the information.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 1 Detailed Lesson Plan Chapter 3 Therapeutic Communications 90–100 Minutes Chapter 3 objectives can be found on text p. 36. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 I. Case Study Teaching Tips Have a student read the scenario. Tell students the case will be reviewed after the lecture. 10 II. Introduction A. Communication is exchanging common symbols in written or spoken format or other formats (body language, signing, etc.). B. As a paramedic, you must use every available communication strategy to ensure you understand your patients and they understand you. C. Traits that aid communication for the paramedic include liking people and the ability to show empathy. D. Communication consists of a sender, a message, a receiver, and feedback 1. Sender encodes (creates) a message and puts it into an understandable format 2. Receiver must decode (interpret) the message and provide the sender feedback (response to message) 3. Sender must make sure that the message was received accurately E. Failure to communicate can occur because of prejudice, lack of empathy, external distractions, internal distractions, etc. Class Activities Give a student a brief message and have them encode and send to another student. Create a barrier for decoding and feedback (different language, wrong feedback, etc.). 10 III. Building Trust and Rapport A. Your voice, body language, gestures, and eye contact communicate to your patient B. Building trust with your patient involves the following: 1. Introduce yourself 2. Use patient’s name 3. Address your patient properly Discussion Topics With students, discuss each way you can build trust, and how not building a rapport can impede patient care. MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Class Activities  Points to Emphasize©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 2 Chapter 3 objectives can be found on text p. 36. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 4. Modulate your voice 5. Use professional but compassionate tone of voice 6. Explain what you are doing and why 7. Keep a kind, calm facial expression 8. Use appropriate style of communication Class Activities Have several students interview each other as paramedic/patient. Make each patient have a scary, gory, life-threatening injury/illness. Have the paramedic talk to the patient with various facial expressions (angry, scared, etc.). Discuss with students how the patient will look at your facial expression for comfort and confirmation. 20 V.IV. Effective Communication Techniques C.A. Guidelines to effective communication include consistent professionalism, nonjudgmental attitude, and willingness to talk about a concern D.B. Nonverbal communication: 1. Body Language A.a. Distance – intimate space is less than 1.5 ft, and comfortable distance is twice the length of patient’s arm B.b. Relative level – a different message is sent to the patient depending on if you are standing above, below, or at eye level to the patient C.c. Stance – your stance sends a message to the patients 2.1. An open stance –: arms extended, open hands, relaxed large muscles, and nodding head –s shows confidence and ease 2. A closed stance –: arms flexed or tightly crossed over the chest, fists clenched, negative head shaking – shows disinterest, discomfort, disgust, anger, and fear 2. Eye Contact a. Use eye contact as much as possible to convey compassion and sincerity 3. Compassionate touch a.Touching in the right circumstances can convey compassion and a calming measure to your patient Class Activities Have students interview each other using various degrees of distance, eye contact, and stance.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 3 Chapter 3 objectives can be found on text p. 36. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 10 III.V. Interviewing a Patient oA. Asking Questions 1. Open-ended questions allow your patient to respond spontaneously without guided responses 2. The chief complaint should drive the questions asked by the paramedic a.Continue to ask open-ended questions b.Use direct questions when necessary c.Ask only one question at a time, and allow the patient to complete his answers d.Listen to the patient’s complete response before asking the next question e.Do not allow interruptions, if possible oB. Active Listening a.1.The art of listening well is a trait few people practice b.2.Listening is crucial for a skilled clinician, as you will learn valuable information about your patient c.3. Development of good communication skills takes time and practice d.4.Several practices promote active listening: a. Silence – allows patient to gather thoughts b. Reflection – echoing message back to patient c. Facilitation – encouraging patient to provide more information d. Empathy – letting patient know you understand e. Clarification – asking patient to help you understand f. Confrontation – focusing patient on one particular factor of interview g. Interpretation – stating how you are interpreting the information h. Asking about feelings – asking patient how they he feels about what they arehe is experiencing i. Explanation – sharing facts and objective information j. Summarization – reviewing the interview e.5.Several practices are “traps of interviewing” or common errors that can hinder the patient interview Points to Emphasize Explain to students the importance of using effective interviewing techniques and how it helps them to do their jobs more efficiently. Discussion Topics Talk with students about how they can avoid some of the traps of interviewing. Discuss techniques that they have used that have worked and those that have not.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 4 Chapter 3 objectives can be found on text p. 36. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes a. Providing false assurances b. Giving advice and abusing authority c. Using avoidance language and distancing d. Talking too much e. Interrupting the patient and using “why did you” questions A.C. Observing Your Patient a.1.Look at external signs during your patient interview that can give you indication of your patient’s condition b.2. Observe level of consciousness, body movements, mood, energy level, eye contact, and behavior B.D. Using Appropriate Language a.1.Refrain from sophisticated medical terminology b.2. Obstacles include cultural differences, language, deafness, speech impediments, and blindness 20 a.VI. Special Needs and Challenges a.A. Most patients are more than willing to answer questions b.B. Some patients may require more time and various techniques to establish rapport and wiliness to answer questions c.C.Some patients you encounter will have different communication needs a.1.Children a. Talk to the caregivers b. Get down to their eye level and stay calm c. Talk to the children and answer his their questions honestly, and most importantly, build trust b.2.Elderly Patients a. Be respectful and courteous b. Allow the patients time to talk and answer questions c.Use compassionate touch c.3. Patients with Sensory Impairment a. Blind, sight-ed impaired, deaf, or hearing-g impaired patients b.Retrieve any necessary communication aids c. Allow more time for the patient interview d. Remember that you may have to change your Class Activities As in the other class activities regarding communication, have students role play communication scenarios listed in special challenges and needs. Allowing actual dialog will enforce proper communication techniques for students.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 5 Chapter 3 objectives can be found on text p. 36. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes communication technique to accommodate the patient’s needs d.4.Angry, Hostile, or Uncooperative Patients a. Set limits and establish boundaries with hostile patients to maintain scene safety b. Avoid confrontation e.5.Sensitive Topics a. Remain calm, objective, and nonjudgmental when questioning a patient about a sensitive subject b. Let the patient know that what they he tells you is confidential information f.6. Silence a. Stay calm and observe your patient’s nonverbal cues b. Determine if your behavior has caused the patient to stop communicating with you g.7.Overly Talkative Patients a. Focus on important aspects of the interview b. Ask some closed-ended questions for important information c. Realize that your patient may just want someone to talk to d.Try not to become impatient h.8.Patients with Multiple Symptoms a. Sort through the multiple complaints b. Determine why the patient called, to help lead you to the actual chief complaint i.9. Anxious Patients a. Anxiety natural reaction to stress b.Observe the anxiety in your patient and encourage your patient to speak freely about it j.10. Patients Needing Reassurance a. Listen to your patient before offering reassurance k.11. Intoxicated Patients a. Scene safety is most important b. Avoid judgment, confrontation, etc. l.12. Crying Patients A.a. Accept that crying may be a normal response for©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 6 Chapter 3 objectives can be found on text p. 36. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes your patient m.13. Depressed Patients i.a. Determine that your patient is not suicidal n.14. Patients with Confusing Behaviors or Histories i.a. Focus assessment on patient’s mental status (thought, perceptions, mood) ii.b. Differentiate between delirium and dementia, if possible o.15. Patients with Limited Intelligence i.a. Do not assume that your patient will not be able to give you his medical history, or tell you what his complaint is ii.b. Show compassion and patience iii.c. If a patient has mental retardation that impedes his communication abilities, use the family/caregiver or friends p.16. Talking with Familyies or Friends i.a. Use family and friends when encountering a patient who is unable to give you any information ii.b. Patient confidentiality is always a priority, even when using family and friends 5 b.VII. Transferring Patient Care a.A. Using correct communication techniques allows for proper patient transfers between medical professionals b.B. Always listen and echo responses when needed Discussion Topics Discuss with students what can happen to a patient when critical information is not transferred, such as allergies, complaints, etc. 5 c.VIII. Summary a.A. To provide the best care for your patients, you must be able to quickly and effectively gather information about the patient b.B. Pay attention to your body language, tone of voice, facial expressions, and personal space c.C. Showing compassion and empathy will allow you to become an ally to your patients and others©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 7 Chapter 3 objectives can be found on text p. 36. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 III.IX. Case Study Class Activities Discuss the case with students now that they are familiar with the chapter. 5 IV.X. You Make the Call Class Activities Read and discuss the call and questions as a group. 5 V.XI. Review Questions Class Activities Pass out review questions before the lesson starts. Have students answer them. Then go over the questions again after the lecture to assess their students’ understanding of the information. Comment [MOU1]: Shouldn't this be listed at the top of the lesson?©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 1 Detailed Lesson Plan Chapter 4 History Taking 100–110 Minutes Chapter 4 objectives can be found on text p. 55. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 I. Case Study Teaching Tips Have a student read the scenario. Tell students the case will be reviewed after the lecture. 5 II. Introduction A. The majority of your medical field diagnosis is based on patient history B. A patient history is a well-structured yet flexible tool that is the focal point for your relationship with the patient C. A differential field diagnosis (list of causes) is necessary in explaining signs and symptoms that your patient is complaining of 5 III. Preliminary Data A. Always record the date and time of the physical exam B. Determine your patient’s age, sex, race, birthplace, and occupation C. Record the source of the information you have received D. Establish reliability of information Critical Thinking Questions Why could patient care be impeded if the reliability of the information given is not established? 10 IV. Chief Complaint A. The pain, discomfort, or dysfunction that caused your patient to request help B. “Why did you call us today?” allows your patient to answer freely C. Remember that the chief complaint is a sign or symptom noticed by the patient or bystander, while the primary problem is the principal medical cause of the complaint D. Try to document your patient’s chief complaint in the patient’s own words Class Activities Have the class write down examples of chief complaints, then match them with primary problems. (For example, pain in the arm vs. fractured ulna, etc.) MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Critical Thinking Questions  Class Activities  Points to Emphasize  Knowledge Application©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 2 Chapter 4 objectives can be found on text p. 55. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 10 V. Present Problem A. Once the chief complaint has been determined, look at your patient’s complaints in greater detail B. Using the acronym OPQRST-ASPN allows a template for exploring patient complaints 1. Onset: Did the problem develop suddenly or gradually? What was the patient doing? 2. Provocation/Palliation: Does anything make the symptoms worse or better? 3. Quality: Is the pain crushing, tearing, sharp, dull, crampy, etc.? 4. Region/radiation: Does the pain stay in one location or move? 5. Severity: On a scale of 1 to 10, rate the pain 6. Time: When did the symptoms begin? Constant or intermittent? How long does it last? Any previous episodes? 7. Associated Symptoms: Are there any other symptoms? 8. Pertinent Negatives: Are there any likely symptoms absent? Discussion Topics Discuss with students how the OPQRSTASPN can actually lead them to the correct field diagnosis by ruling in or out particular complaints. 10 VI. Past Medical History A. The past medical history may provide insight into your patient’s current chief complaint. Look at: 1. General state of health 2. Childhood diseases 3. Adult diseases: Is there a preexisting medical problem? Is the patient on special diets or prescribed medications? What is the name of the patient’s physician? 4. Current medications: Identify all OTC medications, prescriptions, home remedies, vitamins, and minerals a patient is taking 5. Allergies 6. Psychiatric illnesses 7. Accidents or injuries: Has a patient had an injury in the past that has led to hospitalization? Could a past injury be a factor with the current problem? 8. Surgeries or hospitalizations 9. For trauma patients, use SAMPLE: Signs and symptoms, Allergies, Medications, Past history, Last time eaten, Events Class Activities Have students interview each other with mock past medical histories.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 3 Chapter 4 objectives can be found on text p. 55. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 15 VII. Family/Social History A. Any information from the family or social history that is relevant to your patient’s current complaint 1. Home situation and significant others 2. Daily life 3. Tobacco 4. Alcohol, drugs, and related substances a. Make sure to only gather information and not pass judgment so that you can direct your patient’s medical treatment b. The CAGE questionnaire can be used to determine the presence of alcoholism 5. Diet 6. Screening tests 7. Immunizations 8. Sleep 9. Exercise and leisure activities 10. Environmental hazards 11. Use of safety measures 12. Important experiences 13. Religious beliefs 14. The patient’s outlook Discussion Topics Discuss with students how obtaining a family or social history can provide insight into the patient’s current problem. Points to Emphasize In a nonemergency situation there is more time to gain an in-depth understanding of a patient’s medical history, but in an emergency setting there will not be. Talk with students about how to go about gaining the most important facts from a patient in an emergency setting. 15 VIII. Review of Body Systems A. This is a system-by-system review of the body by questions to help identify problems in your patient that have not been previously mentioned 1. General: What is the patient’s usual weight? Any recent weight changes? Does your patient experience fatigue, fever, chills, night sweats, etc.? 2. Skin, Hair, Nails: Are there any new rashes, lumps, or changes in nails or hair? 3. Head, Eyes, Ears, Nose, and Throat (HEENT): Has your patient had headaches, hearing problems, vision problems, etc.? Does the patient wear dentures? 4. Chest and Lungs: Is your patient wheezing, coughing up blood, etc.? Class Activities This is an asking and answering activity that the student perfects with practice. Since it is a system-by-system review with questions, the more students can ask these questions, the better their patient interviews will be. Knowledge Application Assign the Body Systems for homework. Give all students the list of body systems and require them to write out the questions that need to be asked.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 4 Chapter 4 objectives can be found on text p. 55. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5. Heart and Blood Vessels: Does your patient have high blood pressure, murmurs, chest pain, etc.? 6. Lymph Nodes: Are there any enlargements or tenderness? 7. Gastrointestinal System: Does your patient have trouble swallowing, heartburn, nausea/vomiting, etc.? 8. Genitourinary System: Is she having trouble with urination? 9. Male Genitalia: Is he experiencing a hernia, any discharge, or a possible STD? 10. Female Genitalia: When was your patient’s first period? Any difficulties with periods? Any pregnancies and deliveries, and is she postmenopausal? 11. Musculoskeletal System: Is there muscle or joint pain? 12. Neurologic System: Has the patient experienced fainting, blackouts, seizures, etc.? 13. Hematologic System: Is the patient anemic; is there any recent fatigue, or easy bruising? 14. Endocrine System: Has your patient been diagnosed with a thyroid problem, does she experience heat or cold intolerance? 15. Psychiatric History: Does your patient have feelings of nervousness, stress, tension, depression, etc.?©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 5 Chapter 4 objectives can be found on text p. 55. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 10 IX. Clinical Reasoning A. This is gathering, evaluating, and synthesizing information in a short period of time B. You will use your senses, education, training, clinical experience, and decision-making skills C. You will develop the ability to think and make decisions while under pressure D. Collect this information to make the decisions necessary for your patient 1. Draw on your fundamental knowledge and abilities of anatomy and physiology 2. Gather patient history and relevant information 3. Form a differential diagnosis based on information obtained and patient’s chief complaint 4. Sort through the ambiguities and differentiate between relevant and irrelevant data 5. Recognize patterns by analyzing and comparing factors that will rule in or out a diagnosis 6. Defend your decisions Critical Thinking Questions Why do you think that pathophysiology is so important for paramedic care? Do you believe that understanding the human body in terms of pathophysiology will affect the paramedic’s decisions and patient care? Explain why. 5 X. Summary A. A comprehensive history and physical exam will provide you the information you need to begin a treatment regimen B. The most important step is to document the answers to your questions as you receive them 5 XI. Case Study Class Activities Discuss the case with students now that they are familiar with the chapter. 5 XII. You Make the Call Class Activities Read and discuss the call and questions as a group.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 6 Chapter 4 objectives can be found on text p. 55. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 XIII. Review Questions Class Activities Pass out review questions before the lesson starts. Have students answer them. Then go over the questions again after the lecture to assess students’ understanding of the information.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 1 Detailed Lesson Plan Chapter 5 Secondary Assessment 200–210 Minutes Chapter 5 objectives can be found on text p. 70. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 I. Case Study Teaching Tips Have a student read the scenario. Tell students the case will be reviewed after the lecture. 5 II. Introduction A. Secondary assessment is a focused physical exam that investigates the areas involved in the patient’s primary problem or complaint B. Major anatomic regions and body systems are assessed during this exam C. Exam may be limited in prehospital setting based on patient needs 5 III. General Approach A. How you approach the patient will set the stage for the patient assessment B. Patients may feel apprehensive, exposed, or vulnerable etc. C. Perform the assessment systematically and efficiently with compassion and interest Critical Thinking Questions How do you think a patient would respond to a physical examination if done by a paramedic who appeared uncomfortable or unsure of the procedure? What can the paramedic do to change the patient’s opinion? 10 IV. Physical Exam Techniques A. Inspection 1. Informed observation that begins when meeting your patient 2. Inspection involves looking at the patient and surroundings B. Palpation 1. Using sense of touch to gather information, including temperature, moisture, texture, and movement 2. Keeping your hands warm, fingernails short, and a gentle touch to allow for a comfortable assessment for patient Class Activities Have students pair up and practice the four physical exam techniques on each other. MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Critical Thinking Questions  Class Activities  Knowledge Application©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 2 Chapter 5 objectives can be found on text p. 70. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes C. Percussion 1. Production of sound waves by striking one object against another 2. Types of percussion include direct, indirect, and blunt 3. Percussion sounds include tympany, hyperresonance, resonance, dull, and flat 4. Noise does prevent effective percussion D. Auscultation 1. Listening for sounds 2. Lungs, heart, intestines, and major blood vessels 3. Use of working stethoscope necessary for correct auscultation 15 V. General Survey A. Mental Status 1. Level of consciousness 2. Appearance and behavior 3. Speech and language 4. Mood 5. Thoughts and perceptions 6. Insight and judgment 7. Memory and attention B. General Appearance 1. Signs of distress 2. Apparent state of health 3. Vital statistics 4. General stature 5. Sexual development 6. Skin color and obvious lesions 7. Posture, gait, and motor activity 8. Dress, grooming, and personal hygiene 9. Breath or body odors 10. Facial expressions C. Vital Signs 1. Respiration a. Respiratory rate b. Respiratory effort Discussion Topics Discuss with students what they are looking for with mental status and general appearance. Explain how changes in these two categories can indicate a medical/trauma issue. Class Activities Have students pair up and practice the general survey on each other.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 3 Chapter 5 objectives can be found on text p. 70. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes c. Tidal volume (depth and pattern of breathing) 2. Pulse a. Rhythm, rate, and quality b. Radial, carotid are locations for pulse c. Bradycardia may indicate increased parasympathetic stimulation, head injury, hypothermia, severe hypoxia, or overdose d. Treatment occurs if bradycardia compromises cardiac output e. Tachycardia an early indication of shock 3. Blood Pressure a. Force of blood against arterial walls as heart contracts and relaxes b. Systolic and diastolic measurements c. Korotkoff sounds are the blood hitting the arterial walls d. Correlate patient blood pressure with patient presentation (perfusion) e. Pulse pressure is the difference between systolic and diastolic (normal pulse pressure is 30–40 mmHg) f. Determine if hyper- or hypotension is present 4. Body Temperature a. Normal temperature is 98.6°F or 37°C b. Determine if hyper- or hypothermia is present 5. Capillary Refill a. Pinch finger and let go, allowing blood to refill in area b. Less than 2 seconds in adults is a normal response c. More reliable in infants and children 6. Oral Mucosa Color a. Reliable indicator of central circulation and oxygenation b. Should be pinkish-red, smooth, and moist 5 VI. Anatomic Region Examination A. Situation of patient, your experience, and common sense will indicate how thorough or narrow the focus of the examination needs to be Class Activities Have students pair up and perform a focused physical exam on each other.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 4 Chapter 5 objectives can be found on text p. 70. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes Knowledge Application For homework, write out the physical exam, leaving out what students are looking for. Have each student write out what they are looking for when performing the physical exam. This can be done for the remainder of the chapter. 10 VII. Skin A. Anatomy and Physiology 1. Largest organ, 15 percent of our total body weight 2. Layers include epidermis (outer layer) and dermis, which lies above subcutaneous fat B. Assessment 1. Color (normal, pale, cyanotic, jaundiced) 2. Moisture (dry, moist, oily) 3. Temperature (warm, cold) 4. Texture (rough, smooth, scaly, thick, thin) 5. Mobility and turgor (elasticity of skin, tenting, edema) 6. Lesions (a disruption of normal tissue; shape, color, arrangement) Discussion Topics Discuss with students how their objectives change during the comprehensive physical exam compared to the primary and secondary assessment. Discuss how much more in-depth they need to go during this step. 5 VIII. Hair A. Anatomy and Physiology 1. Tactile sensory organ B. Assessment 1. Inspect and palpate (color, quality, quantity) 2. Scalp (dry, flaky, scaling, sores, lesions, lumps, etc.) Class Activities Have students practice inspecting and palpating another student’s hair and scalp. 5 IX. Nails A. Anatomy and Physiology 1. Most distal end of fingers and toes 2. Can indicate the past 3 months of patient’s life, based on growth B. Assessment 1. In medical patients, can indicate cardiorespiratory diseases 2. Look for clubbing, color, lesions, ridging, grooves, depressions, Knowledge Application For homework, have students write the definitions for the various disorders of the nails. For a more visual take, pass out a paper with blank nails on it and have students draw the disorders.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 5 Chapter 5 objectives can be found on text p. 70. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes pitting, paronychia, onycholysis, Terry’s nails, white spots, transverse lines, psoriasis, and Beau’s lines 10 X. Head A. Anatomy and Physiology 1. Acronym SCALP allows for remembrance of layers: skin, connective tissue, aponeurosis, loose tissue, and periosteum 2. Vascular, allows for protection and insulation of brain 3. Consists of cranium and face B. Assessment 1. Inspect and palpate (wounds, bleeding) 2. Symmetrical, raccoon eyes, Battle’s sign, and facial bone integrity Teaching Tips Go over the anatomy and physiology of the head with students. Review the injuries or medical issues that can occur with the head and brain. Class Activities Have students perform an assessment with each other that focuses on the head. 10 XI. Eyes A. Anatomy and Physiology 1. External – eyelid, conjunctiva, lacrimal gland, ocular muscles, and the bony skull orbit 2. Internal – sclera, cornea, iris, lens, and retina B. Assessment 1. Visual acuity, visual fields, external eyes for symmetry, lid shape and size, shape and symmetry of pupils Teaching Tips Go over the anatomy and physiology of the eyes with students. Review the injuries or medical issues that can occur with the eyes. Review the visual acuity chart with students. Class Activities Have students perform an assessment with each other that focuses on the eyes. 5 XII. Ears A. Anatomy and Physiology 1. Outer, middle, and inner ear B. Assessment 1. Observe ears, inspect for discharge, and use otoscope to view tympanic membrane Teaching Tips Go over the anatomy and physiology of the ear with students. Review the injuries or medical issues that can occur with the ears.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 6 Chapter 5 objectives can be found on text p. 70. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes Class Activities Have students practice using an otoscope. 5 XIII. Nose A. Anatomy and Physiology 1. Nasal bones, cartilage, and bony septum that divides right and left cavities B. Assessment 1. Shape, color, nasal flaring, deformities, and swelling and tenderness Teaching Tips Go over the anatomy and physiology of the nose with students. Review the injuries or medical issues that can occur with the nose. 5 XIV. Mouth A. Anatomy and Physiology 1. Lips, tongue, gums, and teeth B. Assessment 1. Symmetrical shape, lesions, wounds, bleeding, loose or missing teeth, and odors Teaching Tips Go over the anatomy and physiology of the mouth with students. Review the injuries or medical issues that can occur with the mouth. 10 XV. Neck A. Anatomy and Physiology 1. Spinal cord, blood vessels, esophagus, trachea, thyroid gland, and larynx B. Assessment 1. Symmetrical shape, masses, deformities, open wounds, bruising, bleeding, tracheal deviation, jugular vein distention, and subcutaneous emphysema Teaching Tips Go over the anatomy and physiology of the neck with students. Review the injuries or medical issues that can occur with the neck. 10 XVI. Chest and Lungs A. Anatomy and Physiology 1. Sternum, 12 pairs of ribs, and spinal column 2. Mediastinum, lungs, and pleura B. Assessment 1. Auscultation of lung sounds, respiratory effort, integrity and Teaching Tips Go over the anatomy and physiology of the chest and lungs with students. Review the injuries or medical issues that can occur with the chest and lungs.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 7 Chapter 5 objectives can be found on text p. 70. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes symmetrical movement of chest wall, and percussion of chest Class Activities Play a CD of various lung sounds for students and have them identify the medical or traumatic issue that can occur with each sound. 10 XVII. Heart and Blood Vessels A. Anatomy and Physiology 1. Heart, aorta, pulmonary artery, superior venae cavae 2. Cardiac output is amount of blood heart ejects each minute (heart rate × stroke volume) 3. Stroke volume is amount of blood ejected in one beat 4. Preload, afterload, and contractile force are factors of stroke volume B. Assessment 1. Heart sounds, skin color, carotid arteries for bruits or thrills, venous congestions, pulses and blood pressure, and edema to lower extremities Teaching Tips Go over the anatomy and physiology of the heart and blood vessels with students. Review the injuries or medical issues that can occur with the heart and blood vessels. Class Activities Listen to a CD of the different heart sounds. 10 XVIII. Abdomen A. Anatomy and Physiology 1. Four quadrants of abdomen 2. Major organs: digestive, urinary, female and male reproductive, cardiovascular, and lymphatic system B. Assessment 1. Examine any areas with pain last 2. Auscultate before percussing or palpating 3. Cullen’s sign or Grey Turner’s sign indicate intraabdominal bleeding 4. Ascites, pulsating masses, obvious discoloration, lesions, and borborygmi (prolonged gurgling sounds) Teaching Tips Go over the anatomy and physiology of the abdomen with students. Review the injuries or medical issues that can occur with the abdomen. Knowledge Application Assign a definition of the meanings of different signs of bleeding, fluid buildup, etc., for students to complete. For a visual, pass out a page with an abdominal picture and have students color in and name the various areas of possible bleeding.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 8 Chapter 5 objectives can be found on text p. 70. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 XIX. Female Genitalia A. Anatomy and Physiology 1. External genitalia highly vascular B. Assessment 1. Rarely expected to examine unless cases of trauma or abuse 2. Maintain privacy and explain to patient what you are doing 3. Discharge, trauma, and odor Teaching Tips Go over the anatomy and physiology of the female genitalia with students. Review the injuries or medical issues that can occur with the female genitalia. 5 XX. Male Genitalia A. Anatomy and Physiology 1. External organs: penis and scrotum B. Assessment 1. Rarely examined except for trauma 2. Maintain privacy and explain to patient what you are doing 3. Discharge, trauma, inflammation, odor, lumps, swelling, testicular torsion, and priapism Teaching Tips Go over the anatomy and physiology of the male genitalia with students. Review the injuries or medical issues that can occur with the male genitalia. 5 XXI. Anus A. Anatomy and Physiology 1. Most distal end of GI system B. Assessment 1. Normally not a prehospital assessment unless patient presents with rectal bleeding 2. Maintain privacy and explain what you are doing 3. Place patient on left side with knees flexed and buttocks near edge of examination table Teaching Tips Go over the anatomy and physiology of the anus and rectum with students. Review the injuries or medical issues that can occur with the anus and rectum. Class Activities Obtain an occult blood fecal testing strip for students to view. 15 XXII. Musculoskeletal System A. Anatomy and Physiology 1. 206 bones, joints, muscles, tendons, ligaments, and cartilage 2. Wrists, hands, fingers, elbows, shoulders, ankles, feet, knees, hips, and spine B. Assessment 1. Function and structure of joints, bones, and surrounding tissues 2. Range of motion, crepitus, tenderness, movement, swelling, Teaching Tips Go over the anatomy and physiology of the musculoskeletal system with students. Review the injuries or medical issues that can occur with the musculoskeletal system.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 9 Chapter 5 objectives can be found on text p. 70. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes symmetrical impairment, redness, shortened or lengthened limbs, obvious deformity, alignment, and spinal curvatures 15 XXIII. Neurologic System A. Are findings symmetrical or unilateral? B. If unilateral, are findings from CNS or PNS? 1. Cranial nerves – 12 pairs originating from base of brain, provide sensory, and motor innervation 2. Motor system – 31 pairs arising from spinal foramina; coordinated, skilled movements 3. Sensory system – posterior root of peripheral nerves; assessing involves testing for pain, light touch, temperature, vibration, position, discriminative sensations 4. Deep tendon reflexes – connection of some sensory impulses directly to motor neurons; use of reflex scale allows for reflex assessment Teaching Tips Go over the anatomy and physiology of the neurologic system with students. Review the injuries or medical issues that can occur with the neurologic system. Class Activities Have students review the cranial and spinal nerves, as well as the locations of dermatomes. Have students locate reflexes and review the reflex scale. 10 XXIV. Reassessment A. Mental Status – repeat AVPU B. Airway Patency – patency can change instantly, be vigilant for potential problems C. Breathing Rate and Quality – changes can indicate improvement or deterioration, constant reevaluation is necessary D. Pulse Rate and Quality – compare current rates with earlier measurements E. Skin Condition – skin quickly reflects hemodynamic status F. Transport Priorities – priority may change based on patient’s condition G. Vital Signs – reassessment allows for trending of potential problems, for critical patients reassess every 5 minutes H. Focused Assessment – review patient’s chief complaint with findings; repeat focused assessment based on patient I. Effects of Interventions – evaluate the effects of any interventions J. Management Plans – evaluate whether your care is working; consider other Class Activities Have each student perform a secondary assessment on a partner.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 10 Chapter 5 objectives can be found on text p. 70. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes options of treatment, if necessary 5 XXV. Summary A. Knowledge of anatomy and physiology allows the paramedic to complete a comprehensive examination and thorough secondary assessment B. A systemic head-to-toe examination will help to prevent overlooking any medical or trauma issue in your patient C. Inspection, palpitation, percussion, and auscultation are essential skills for all paramedics 5 XXVI. Case Study Class Activities Discuss the case with students now that they are familiar with the chapter. 5 XXVII. You Make the Call Class Activities Read and discuss the call and questions as a group. 5 XXVIII. Review Questions Class Activities Pass out review questions before the lesson starts. Have students answer them. Then go over the questions again after the lecture to assess students’ understanding of the information.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 1 Detailed Lesson Plan Chapter 6 Patient Monitoring Technology 160–170 Minutes Chapter 6 objectives can be found on text pp. 171-172. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 I. Case Study Teaching Tips Have a student read the scenario. Tell students the case will be reviewed after the lecture. 5 II. Introduction A. The use of new technology has enabled the paramedic to provide better patient care throughout the past 40 years B. The new technology allows us to recognize dangerous trends occurring in our patients, to better document those trends and the care provided, and present this information to the emergency department staff 25 III. ECG Monitoring A. Anatomy and Electrophysiology 1. The heart is a mechanical pump that runs on electricity 2. Right side receives oxygen-poor blood and delivers to lungs for oxygen/CO2 exchange 3. Left side receives oxygen-rich blood from lungs and delivers to body 4. Layers of heart include myocardium (muscle perfused by coronary arteries) and endocardium (houses electrical system) 5. Electrical system of heart composed of specialized excitatory and conductive fibers that conduct electrical impulses 6. The pacemaker is the sinoatrial (SA) node located in the right atrium 7. Depolarization (sodium and potassium crossing cell membrane) generates the impulse, causing the cell to be “charged” and conducting to adjacent cells Teaching Tips “Treat the patient, not the monitor” should be a constant reminder to students. Draw the blood flow of the heart on a whiteboard for students. This allows a great visual for understanding. . MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Class Activities  Points to Emphasize©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 2 Chapter 6 objectives can be found on text pp. 171-172. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes B. Technology 1. ECG detects electrical voltage changes caused when the heart muscle depolarizes during each heartbeat 2. Bipolar leads: one positive and one negative lead 3. Lead I: – RA, + LA (positive deflection) 4. Lead II: – RA, + LL (positive deflection) 5. Lead III: – LA, + LL (positive deflection) 6. Einthoven’s triangle is an electrode placement for three bipolar leads (two arms and left leg electrodes form corners of triangle) 7. ECG paper is horizontal markings that represent time and vertical markings that represent voltage amplitude 8. ECG components are P wave, PR interval (PRI), QRS complex, ST segment, T wave, and U wave 9. Cardiac monitor essential in assessing and managing patient’s cardiac rhythm and can perform manual and automated defibrillation C. Limitations 1. Cannot tell paramedic if heart is pumping efficiently or effectively or at all 2. The most common lead in prehospital care is Lead II 3. Single lead reading cannot provide the necessary information to make a diagnosis 4. Artifacts (deflections caused by factors other than the heart’s electrical activity) may occur from shivering, movement, tremors, and equipment issues 5. Diaphoretic patients may need to be dried to allow for electrodes to adhere D. Indications 1. Routine for any patient who needs heart rhythm monitoring 2. Patients with chest pain, irregular pulses, possible MIs, fast or slow heart rates, and any patient receiving ALS require ECG monitoring E. Procedure 1. Make sure skin is clean and free of hair 2. Try to use patient’s chest wall instead of extremities, if possible Class Activities Bring out the monitor and allow students to practice applying the electrodes and running a strip on each other. Have them look at the different leads and apply the leads based on Einthoven’s triangle. Enlarge an ECG strip (blank) and pass out to students. As a group, mark each electrical wave that is represented, along with time and amplitude. Points to Emphasize Make sure that students understand that the heart’s electrical signal moves downward, toward the ventricle, which is why the positive leads are located on the left. Have them put a negative lead on the left and a positive on the right and discuss why the reading is deflected downward.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed. 3 Chapter 6 objectives can be found on text pp. 171-172. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 15 IV. Twelve-Lead ECG Acquisition A. Pathophysiology of Acute Coronary Syndromes 1. Heart muscle nourished by right and left coronary arteries 2. Heart demands a constant supply of oxygen and nutrients 3. Zones of myocardial damage include ischemia, injury, and infarction 4. Goal of emergency services managing chest pain is to stop the infarction process B. Technology 1. 12-lead shows the heart from 12 different directions and two different planes 2. Bipolar (Leads I, II, III), unipolar (aVR, aVL, aVF), and precordial (V1–V6) C. Limitations 1. Only provides information on electrical activity of patient’s heart, not the mechanical pump 2. ECG changes can occur with postural changes 3. 12-lead is a