Standard

R State Standard £ Institutionally Developed College: n/a

EMS 130 – Respiratory Emergencies
Course Description This unit is designed to help the Paramedic assess and treat a wide variety of respiratory related illnesses in the pediatric and adult patient. Topics include a review of anatomy and physiology, pathophysiology of foreign body airway obstruction, recognition of respiratory compromise, use of airway adjunctive equipment and procedures, current therapeutic modalities for bronchial asthma, chronic bronchitis, emphysema, spontaneous pneumothorax, and hyperventilation syndromes. This section also provides expanded information for adult respiratory distress syndrome, pulmonary thromboembolism, neoplasms of the lung, pneumonia, emphysema, pulmonary edema, and respiratory infections. This course provides instruction on topics in Division 2 (Airway), Section 1 (Airway Management and Ventilation) and Division 5 (Medical), Section 1 (Respiratory) of the USDOT/NHTSA Paramedic National Standard Curriculum.
Competency Areas	Hours
Anatomy and Physiology of the Airway & Respiratory System	Class	4
Control and Ventilation of the Airway	D. Lab	2
Assessment and Management of Respiratory Emergencies	P. Lab/O.B.I.	0
	Credit	5

Prerequisite:	AHS 101
Corequisite:	EMS 126, EMS 127, EMS 128, EMS 129

Course Guide

Competency	After completing this section, the student will be able to:	Hours
		Class	D.Lab	P.Lab/
				O.B.I.
ANATOMY AND PHYSIOLOGY OF THE AIRWAY & RESPIRATORY SYSTEM		12	6	0
2-1.3	Identify the anatomy of the upper and lower airway. (C-1)
2-1.4	Describe the functions of the upper and lower airway. (C-1)
2-1.5	Explain the differences between adult and pediatric airway anatomy. (C-1)
2-1.6	Define gag reflex. (C-1)
2-1.7	Explain the relationship between pulmonary circulation and respiration. (C-3)
2-1.8	List the concentration of gases that comprise atmospheric air. (C-1)
2-1.9	Describe the measurement of oxygen in the blood. (C-1)
2-1.10	Describe the measurement of carbon dioxide in the blood. (C-1)
2-1.11	Describe peak expiratory flow. (C-1)
2-1.12	List factors that cause decreased oxygen concentrations in the blood. (C-1)
2-1.13	List the factors that increase and decrease carbon dioxide production in the body. (C-1)
2-1.14	Define atelectasis. (C-1)
2-1.15	Define FiO2. (C-1)
2-1.16	Define and differentiate between hypoxia and hypoxemia. (C-1)
2-1.17	Describe the voluntary and involuntary regulation of respiration. (C-1)
2-1.18	Describe the modified forms of respiration. (C-1)
2-1.19	Define normal respiratory rates and tidal volumes for the adult, child, and infant. (C-1)
2-1.20	List the factors that affect respiratory rate and depth. (C-1)
2-1.22	Define pulsus paradoxes. (C-1)
5-1.2	Identify and describe the function of the structures located in the upper and lower airway. (C-1)
5-1.3	Discuss the physiology of ventilation and respiration. (C-1)
CONTROL AND VENTILATION OF THE AIRWAY		16	10	0
2-1.1	Explain the primary objective of airway maintenance. (C-1)
2-1.2	Identify commonly neglected prehospital skills related to airway. (C-1)
2-1.21	Explain the risk of infection to EMS providers associated with ventilation. (C-3)
2-1.23	Define and explain the implications of partial airway obstruction with good and poor air exchange. (C-1)
2-1.24	Define complete airway obstruction. (C-1)
2-1.25	Describe causes of upper airway obstruction. (C-1)
2-1.26	Describe causes of respiratory distress. (C-1)
2-1.27	Describe manual airway maneuvers. (C-1)
2-1.28	Describe the Sellick (cricoid pressure) maneuver. (C-1)
2-1.29	Describe complete airway obstruction maneuvers. (C-1)
2-1.30	Explain the purpose for suctioning the upper airway. (C-1)
2-1.31	Identify types of suction equipment. (C-1)
2-1.32	Describe the indications for suctioning the upper airway. (C-3)
2-1.33	Identify types of suction catheters, including hard or rigid catheters and soft catheters. (C-1)
2-1.34	Identify techniques of suctioning the upper airway. (C-1)
2-1.35	Identify special considerations of suctioning the upper airway. (C-1)
2-1.36	Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique of tracheobronchial suctioning in the intubated patient. (C-3)
2-1.37	Describe the use of an oral and nasal airway. (C-1)
2-1.38	Identify special considerations of tracheobronchial suctioning in the intubated patient. (C-1)
2-1.39	Define gastric distention. (C-1)
2-1.40	Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for inserting a nasogastric tube and orogastric tube. (C-1)
2-1.41	Identify special considerations of gastric decompression. (C-1)
2-1.42	Describe the indications, contraindications, advantages, disadvantages, complications, and technique for inserting an oropharyngeal and nasopharyngeal airway (C-1)
2-1.43	Describe the indications, contraindications, advantages, disadvantages, complications, and technique for ventilating a patient by: (C-1) a. Mouth-to-mouth b. Mouth-to-nose c. Mouth-to-mask d. One person bag-valve-mask e. Two person bag-valve-mask f. Three person bag-valve-mask g. Flow-restricted, oxygen-powered ventilation device
2-1.44	Explain the advantage of the two person method when ventilating with the bag-valve-mask. (C- 1)
2-1.45	Compare the ventilation techniques used for an adult patient to those used for pediatric patients. (C-3)
2-1.46	Describe indications, contraindications, advantages, disadvantages, complications, and technique for ventilating a patient with an automatic transport ventilator (ATV). (C-1)
2-1.47	Explain safety considerations of oxygen storage and delivery. (C-1)
2-1.48	Identify types of oxygen cylinders and pressure regulators (including a high-pressure regulator and a therapy regulator). (C-1)
2-1.49	List the steps for delivering oxygen from a cylinder and regulator. (C-1)
2-1.50	Describe the use, advantages and disadvantages of an oxygen humidifier. (C-1)
2-1.51	Describe the indications, contraindications, advantages, disadvantages, complications, liter flow range, and concentration of delivered oxygen for supplemental oxygen delivery devices. (C-3)
2-1.52	Define, identify and describe a tracheostomy, stoma, and tracheostomy tube. (C-1)
2-1.53	Define, identify, and describe a laryngectomy. (C-1)
2-1.54	Define how to ventilate with a patient with a stoma, including mouth-to-stoma and bag-valve-mask-to stoma ventilation. (C-1)
2-1.55	Describe the special considerations in airway management and ventilation for patients with facial injuries. (C-1)
2-1.56	Describe the special considerations in airway management and ventilation for the pediatric patient. (C-1)
2-1.57	Differentiate endotracheal intubation from other methods of advanced airway management. (C-3)
2-1.58	Describe the indications, contraindications, advantages, disadvantages and complications of endotracheal intubation. (C-1)
2-1.59	Describe laryngoscopy for the removal of a foreign body airway obstruction. (C-1)
2-1.60	Describe the indications, contraindications, advantages, disadvantages, complications, equipment, and technique for direct laryngoscopy. (C-1)
2-1.61	Describe visual landmarks for direct laryngoscopy. (C-1)
2-1.62	Describe use of cricoid pressure during intubation. (C-1)
2-1.63	Describe indications, contraindications, advantages, disadvantages, complications, equipment and technique for digital endotracheal intubation. (C-1)
2-1.64	Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for using a dual lumen airway. (C-3)
2-1.65	Describe the indications, contraindications, advantages, disadvantages, complications and equipment for rapid sequence intubation with neuromuscular blockade. (C-1)
2-1.66	Identify neuromuscular blocking drugs and other agents used in rapid sequence intubation. (C-1)
2-1.67	Describe the indications, contraindications, advantages, disadvantages, complications and equipment for sedation during intubation. (C-1)
2-1.68	Identify sedative agents used in airway management. (C-1)
2-1.69	Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for nasotracheal intubation. (C-1)
2-1.70	Describe the indications, contraindications, advantages, disadvantages and complications for performing an open crichothyrotomy. (C-3)
2-1.71	Describe the equipment and technique for performing an open cricothyrotomy. (C-1)
2-1.72	Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for transtlaryngeal catheter ventilation (needle cricothyrotomy). (C-3)
2-1.73	Describe methods of assessment for confirming correct placement of an endotracheal tube. (C-1)
2-1.74	Describe methods for securing an endotracheal tube. (C-1)
2-1.75	Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for extubation. (C-1)
2-1.76	Describe methods of endotracheal intubation in the pediatric patient. (C-1)
2-1.77	Defend the need to oxygenate and ventilate a patient. (A-1)
2-1.78	Defend the necessity of establishing and/ or maintaining patency of a patient’s airway. (A-1)
2-1.79	Comply with standard precautions to defend against infectious and communicable diseases. (A-1)
2-1.80	Perform body substance isolation (BSI) procedures during basic airway management, advanced airway management, and ventilation. (P-2)
2-1.81	Perform pulse oximetry. (P-2)
2-1.82	Perform end-tidal CO2 detection. (P-2)
2-1.83	Perform peak expiratory flow testing. (P-2)
2-1.84	Perform manual airway maneuvers, including: (P-2) a. Opening the mouth b. Head-tilt/ chin-lift maneuver c. Jaw-thrust without head-tilt maneuver d. Modified jaw-thrust maneuver
2-1.85	Perform manual airway maneuvers for pediatric patients, including: (P-2) a. Opening the mouth b. Head-tilt/ chin-lift maneuver c. Jaw-thrust without head-tilt maneuver d. Modified jaw-thrust maneuver
2-1.86	Perform the Sellick maneuver (cricoid pressure). (P-2)
2-1.87	Perform complete airway obstruction maneuvers, including: (P-2) a. Heimlich maneuver b. Finger sweep c. Chest thrusts d. Removal with Magill forceps
2-1.88	Demonstrate suctioning the upper airway by selecting a suction device, catheter and technique. (P-2)
2-1.89	Perform tracheobronchial suctioning in the intubated patient by selecting a suction device, catheter and technique. (P-2)
2-1.90	Demonstrate insertion of a nasogastric tube. (P-2)
2-1.91	Demonstrate insertion of an orogastric tube. (P-2)
2-1.92	Perform gastric decompression by selecting a suction device, catheter and technique. (P-2)
2-1.93	Demonstrate insertion of an oropharyngeal airway. (P-2)
2-1.94	Demonstrate insertion of a nasopharyngeal airway. (P-2)
2-1.95	Demonstrate ventilating a patient by the following techniques: (P-2) a. Mouth-to-mask ventilation b. One person bag-valve-mask c. Two person bag-valve-mask d. Three person bag-valve-mask e. Flow-restricted, oxygen-powered ventilation device f. Automatic transport ventilator g. Mouth-to-stoma h. Bag-valve-mask-to-stoma ventilation
2-1.96	Ventilate a pediatric patient using the one and two person techniques. (P-2)
2-1.97	Perform ventilation with a bag-valve-mask with an in-line small-volume nebulizer. (P-2)
2-1.98	Perform oxygen delivery from a cylinder and regulator with an oxygen delivery device. (P-2)
2-1.99	Perform oxygen delivery with an oxygen humidifier. (P-2)
2-1.100	Deliver supplemental oxygen to a breathing patient using the following devices: nasal cannula, simple face mask, partial rebreather mask, non-rebreather mask, and venturi mask (P-2)
2-1.101	Perform stoma suctioning. (P-2)
2-1.102	Perform retrieval of foreign bodies from the upper airway. (P-2)
2-1.103	Perform assessment to confirm correct placement of the endotracheal tube. (P-2)
2-1.104	Intubate the trachea by the following methods: (P-2) a. Orotracheal intubation b. Nasotracheal intubation c. Multi-lumen airways d. Digital intubation e. Transillumination f. Open cricothyrotomy
2-1.105	Adequately secure an endotracheal tube. (P-1)
2-1.106	Perform endotracheal intubation in the pediatric patient. (P-2)
2-1.107	Perform transtracheal catheter ventilation (needle cricothyrotomy). (P-2)
2-1.108	Perform extubation. (P-2)
2-1.109	Perform replacement of a tracheostomy tube through a stoma. (P-2)
ASSESSMENT AND MANAGEMENT OF RESPIRATORY EMERGENCIES		12	4	0
5-1.1	Discuss the epidemiology of pulmonary diseases and conditions. (C-1)
5-1.4	Identify common pathological events that affect the pulmonary system. (C-1)
5-1.5	Discuss abnormal assessment findings associated with pulmonary diseases and conditions. (C-1)
5-1.6	Compare various airway and ventilation techniques used in the management of pulmonary diseases. (C-3)
5-1.7	Review the pharmacological preparations that paramedics use for management of respiratory diseases and conditions. (C-1)
5-1.8	Review the pharmacological preparations used in managing patients with respiratory diseases that may be prescribed by physicians. (C-1)
5-1.9	Review the use of equipment used during the physical examination of patients with complaints associated with respiratory diseases and conditions. (C-1)
5-1.10	Identify the epidemiology, anatomy, physiology, pathophysiology, assessment findings, and management for the following respiratory diseases and conditions: (C-1) a. Adult respiratory distress syndrome b. Bronchial asthma c. Chronic bronchitis d. Emphysema e. Pneumonia f. Pulmonary edema g. Pulmonary thromboembolism h. Neoplasms of the lung i. Upper respiratory infections j. Spontaneous pneumothorax k. Hyperventilation syndrome
5-1.11	Recognize and value the assessment and treatment of patients with respiratory diseases. (A-2)
5-1.12	Indicate appreciation for the critical nature of accurate field impressions of patients with respiratory diseases and conditions. (A-2)
5-1.13	Demonstrate proper use of airway and ventilation devices. (P-1)
5-1.14	Conduct a history and patient assessment for patients with pulmonary diseases and conditions. (P-1)
5-1.15	Demonstrate the application of a CPAP/ BiPAP unit. (P-1)

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Updated: 03/17/09