Download EM-18046 Medical Emergencies for Paramedic with Lab

EM-18046 Medical Emergencies for Paramedic with Lab
Emergency Medical Services
Arkansas Northeastern College
Class Syllabus
Instructor: Benny Ford
Office: Burdette Center
Phone:
E-Mail: [email protected]
Term: Fall 2011
Class Meeting Days: M,T,H,F
Class Meeting Hours: 0830-1630
Class Location: Burdette Center
Course Pre-requisites:
The student must have completed a certified Basic Emergency Medical Technician course of study, and be a
practicing EMT in the State of Arkansas.
Successful completion of EM: 1801? Preparatory for Paramedics.
Course Description:
At the completion of these units, the Paramedic Student will be able to integrate pathophysiology principles and
assessment findings to formulate a field impression and implement the treatment plan for the medical patient.
Medical patients will include those having disease processes involving the following body systems: pulmonary,
cardiology, and neurology.
Recommended Text:
Essentials of Paramedic Care, 2nd Edition by Bryan E. Bledsoe, Robert S. Porter, & William A. Cherry. Published by
Brady – Pearson of New Jersey in 2011.
Rational of Course:
At the completion of these units the student will be able to identify signs and symptoms of patients with cardiac,
pulmonary, neurology emergencies and implement the treatment plan for the medical patient. Skills will include
ECG monitoring, Blood glucose Monitoring, and medication administration.
Course Objectives:
This course is designed to integrate pathophysiology principles and assessment findings to formulate a field
impression and implement the treatment plan for the medical emergencies in advanced prehospital care in
paramedic practice. This includes learning objectives reflecting the cognitive, affective and psychomotor learning
domains. At the conclusion of the Preparatory for Paramedic with Lab the student will be able to:
Cognitive Learning Domain
 Demonstrate knowledge of the pulmonary physiology and how different disease
processes/pathologies affect the emergent patient.
 Demonstrate knowledge of the physiology of the cardiovascular system and how disease/injury
affects the emergent patient.
 Demonstrate knowledge of the physiology of the nervous system along with common diseases
and conditions how disease/injury affects the emergent patient.
Psychomotor Learning Domain
 Assess and recognize the nature and seriousness of a patient’s condition and implement
appropriate care requirements for emergency medical care.

Administer competent, appropriate emergency medical care, based on individualized assessment
findings related to the patients conditions.
 Life, move, position, and otherwise care for the patient, to minimize discomfort and effectively
fulfill the expectations of the Paramedics in a medical emergency.
Affective Learning Domain
 Demonstrate professional behavior, judgment, and attitude toward instructor, peers, and
colleagues while in the classroom and clinical laboratory consistent with the affective domain
behavioral objectives to include: Integrity, Empathy, Self-Motivation, Appearance and Personal
Hygiene, Self-Confidence, Communications, Time Management, Teamwork and Diplomacy,
respect, Patient Advocacy, and Careful Delivery of Service. Refer to the Performance Affective
Domain Evaluation (PADE).
Unit Instructional Objectives:
Chapter 27: Pulmonology:
Rational: Understanding basic physiology of the Pulmonary System and how different disease processes
affect the emergent patient is essential in preparing the Paramedic student in medical emergencies.
Objectives: Upon completion of learning activities, participation in lecture/discussion, and clinical
activities, the student will be provided the opportunity to:
1. Discuss the epidemiology of pulmonary diseases and pulmonary conditions.
2. Indentify and describe the function of the structures located in the upper and lower airway.
3. Discuss the physiology of ventilation and respiration.
4. Indentify common pathological events that affect the pulmonary system.
5. Compare various airway and ventilation techniques used in the management of pulmonary diseases.
6. Indentify the epidemiology, anatomy, physiology, Pathophysiology, assessment findings, and
management for the following respiratory diseases and conditions:
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 lungs.
I. Upper respiratory infections.
J. Spontaneous pneumothorax.
K. Hyperventilation syndrome.
Chapter 28: Cardiology:
Rational: Understanding the physiology of the cardiovascular system, affects of disease and
trauma/injury, along with appropriate assessment and treatment is essential in preparing the Paramedic
to care for patients in medical emergencies in the pre hospital care environment.
Objectives: Upon completion of learning activities, participation in lecture/discussion, and clinical
activities, the student will be provided the opportunity to:
Part 1: Cardiovascular Anatomy and Physiology, ECG Monitoring, and Dysrhythmia Analysis
1. Describe the incidence, morbidity, and mortality of cardiovascular disease.
2. Discuss prevention strategies that mat reduce the morbidity and mortality of cardiovascular disease.
3. Identify the risk factors most predisposing to coronary artery disease.
4. Describe the anatomy of the heart, including the position in the thoracic cavity, layers of the heart,
chambers of the heart, and location and function of cardiac valves.
5. Identify the major structures of the vascular system, the factors affecting venous return, the
components of cardiac output, and the phases of the cardiac cycle.
6.
Define preload, afterload, and left ventricular end-diastolic pressure and relate each to the
pathophysiology of heart failure.
7. Indentify the arterial blood supply to any given area of the myocardium.
8. Compare and contrast the coronary arterial distribution to the major portions of the cardiac
conduction system.
9. Identify the structure and course of all divisions and subdivisions of the cardiac conduction system.
10. Identify and describe how the heart’s pacemaking control, rate, and rhythm are determined.
11. Explain the physiological basis of conduction delay in the AV node.
12. Define the functional properties of cardiac muscle.
13. Define the events comprising electrical potential.
14. List the most important ions involved in the myocardial action potential and their primary function in
this process.
15. Describe the events involved in the steps from excitation to contraction of cardiac muscle fibers.
16. Describe the clinical significance of Starling’s law.
17. Identify the structures of the autonomic nervous system and their effect on heart rate, rhythm, and
contractility.
18. Define and give examples of positive and negative inotropism, chronotropism, and dromotropism.
19. Discuss the pathophysiology of cardiac disease and injury.
20. Explain the purpose of ECG monitoring and its limitations.
21. Correlate the electrophysiological and hemodynamic events occurring throughout the entire cardiac
cycle with various ECG waveforms, segments, and intervals.
22. Identify how heart rates, durations, and amplitudes may be determined from ECG recordings.
23. Relate the cardiac surfaces or areas represented by the ECG leads.
24. Describe a systematic approach to the analysis and interpretation of cardiac dysrhythmias.
25. Describe a systematic approach to the analysis and interpretation of cardiac dysrhythmias.
26. Describe the dysrhythmias originating in the sinus node, the AV junction, the atria, and the ventricles.
27. Describe the process and the pitfalls of differentiating wide QRS complex tachycardia’s.
28. Describe the conditions of pulse less electrical activity.
29. Describe the phenomena of reentry, aberration, and accessory pathways.
30. Identify the ECG changes characteristically produced by electrolyte imbalances and specify their
clinical implications.
31. Identify patient situations where ECG rhythm analysis is indicated.
32. Recognize the ECG changes that may reflect evidence of myocardial ischemia and injury and their
limitations.
33. Correlate abnormal ECG findings with clinical interpretation.
34. Identify the major mechanical, pharmacological, and electrical therapeutic objectives in the
treatment of the patient with any dysrhythmia.
35. Describe artifacts that may cause confusion when evaluating the ECG of a patient with a pacemaker.
36. List the possible complications of pacing.
37. List the causes and the implications of pacemaker failure.
38. Identify additional hazards that interfere with artificial pacemaker function.
39. Recognize the complications of artificial pacemakers as evidenced on an ECG.
Part 2: Assessment and Management of the Cardiovascular Patient
1. Identify and describe the components of the focused history as it relates to the patient with
cardiovascular compromise.
2. Identify and describe the details of inspection, auscultation, and palpation specific to the
cardiovascular system.
3. Identify and define the heart sounds and relate them to hemodynamic events in the cardiac cycle.
4. Describe the differences between normal and abnormal heart sounds.
5. Define pulse deficit, pulsus paradoxus, and pulsus alternans.
6. Identify the normal characteristics of the point of maximum impulse (PMI).
7. Based on field impressions, identify the need for rapid intervention for the patient in cardiovascular
compromise.
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Describe the incidence, morbidity, and mortality associated with myocardial conduction defects.
Identify the clinical indications, components, and the function of the transcutaneous and permanent
artificial cardiac pacing.
Explain what each setting and indicator on a trancutaneous pacing system represents and how the
settings may be adjusted.
Describe the techniques of applying a transcutaneous pacing system.
Describe the characteristics of an implanted pacemaking system.
Describe the epidemiology, morbidity, mortality, and pathophysiology of angina pectoris.
Describe the assessment and management of a patient with angina pectoris.
Identify what is meant by the OPQRST of chest pain assessment.
List other clinical conditions that may mimic signs and symptoms of coronary artery disease and
angina pectoris.
Identify the ECG findings in patients with angina pectoris.
Based on the pathophysiology and clinical evaluation of the patient with chest pain, list the
anticipated clinical problems according to their life-threatening potential.
Describe the epidemiology, morbidity, mortality, and pathophysiology of myocardial infarction.
List the mechanisms by which a myocardial infarction may be produced from traumatic and nontraumatic events.
Identify the primary hemodynamic changes produced in myocardial infarction.
List and describe the assessment parameters to be evaluated in a patient with a suspected
myocardial infarction.
Identify the anticipated clinical presentation of a patient with a suspected acute myocardial
infarction.
Differentiate the characteristics of the pain/discomfort occurring in angina pectoris and acute
myocardial infarction.
Identify the ECG changes characteristically seen during evolution of an acute myocardial infarction.
Identify the most common complications of an acute myocardial infarction.
List the characteristics of a patient eligible for fibrinolytic therapy.
Describe the “window of opportunity” as it pertains to reperfusion of a myocardial injury or
infarction.
Based on the pathophysiology and clinical evaluation of the patient with a suspected acute
myocardial infarction, list the anticipated clinical problems according to their life-threatening
potential.
Specify the measures that may be taken to prevent or minimize complications in the patient
suspected of myocardial infarction.
Describe the most commonly used cardiac drugs in terms of therapeutic effect and dosages, routes of
administration, side effects, and toxic effects.
Describe the epidemiology, morbidity, mortality, and physiology associated with heart failure.
Identify the factors that may precipitate or aggravate heart failure.
Define acute pulmonary edema and describe its relationship to left ventricular failure. Differentiate
between early and late signs and symptoms of left ventricular failure and those of right ventricular
failure.
Define and explain the clinical significance of paroxysmal nocturnal dyspnea, pulmonary edema, and
dependent edema.
List the interventions prescribed for the patient in acute congestive heart failure.
Describe the most commonly used pharmacological agents in the management of congestive heart
failure in terms of therapeutic effect, dosages, and routes of administration, side effects, and toxic
effects.
Define and describe the incidence, mortality, morbidity, pathophysiology, assessment, and
management of the following cardiac related problems:
 Cardiac tamponade
 Hypertensive emergency
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 Cardiogenic shock
 Cardiac arrest
Identify the limiting factor of pericardial anatomy that determines interpericadiac pressure.
Describe how to determine if pulsus paradoxus, pulsus alternans, or electrical alternans is present.
Explain the essential pathophysiological defect of hypertension in terms of Starling’s law of the heart.
Rank the clinical problems of patients in hypertensive emergencies according to their sense of
urgency.
Identify the drugs of choice for hypertensive emergencies, cardiogenic shock, and cardiac arrest,
including their indications, contraindications, side effects, route of administration, and dosages.
Describe the major systemic effects of reduced tissue perfusion caused by cardiogenic shock.
Explain the primary mechanisms by which the heart may compensate for a diminished cardiac output
and describe their efficiency in cardiogenic shock.
Identify the clinical criteria and progressive stages of cardiogenic shock.
Describe the dysrhythmias seen in cardiac arrest.
Explain how to confirm asystole using the 3-leadECG.
Define the terms defibrillation and synchronized cardioversion.
Specify the methods of supporting the patient with a suspected ineffective implanted defibrillation
device.
Describe resuscitation and identify circumstances and situations where resuscitation efforts would
not be initiated.
Identify communication and documentation protocols with medical direction and law enforcement
used for termination of resuscitation efforts.
Describe the incidence, morbidity, mortality, pathophysiology, assessment, and management of
vascular disorders including occlusive disease, phlebitis, aortic aneurysm, and peripheral artery
occlusion.
Identify the clinical significance of claudication and presence of arterial bruits in a patient with
peripheral vascular disorders.
Describe the clinical significance of unequal arterial blood pressure readings in the arms.
Recognize and describe the signs and symptoms of dissecting thoracic or abdominal aneurysm.
Differentiate between signs and symptoms of cardiac tamponade, hypertensive emergencies,
cardiogenic shock, and cardiac arrest.
Utilize the results of the patent history, assessment findings, and ECG analysis to differentiate
between, and provide treatment for, patients with the following conditions
 Cardiovascular disease
 Chest pain
 In need of a pacemaker
 Angina pectoris
 A suspected myocardial infarction
 Heart failure
 Cardiac tamponade
 A hypertensive emergency
 Cardiogenic shock
 Cardiac arrest
Based on the pathophysiology and clinical evaluation of the patient with chest pain, characterize the
clinical problems according to their life-threatening potential.
Given several preprogrammed patients with cardiac complaints, provide the appropriate assessment,
treatment, and transport.
Chapter 29: Neurology:
Rational: A primary understanding of the anatomy and physiology of the nervous system along with
common disease and conditions that effect the CNS are necessary for the EMS Clinician to properly
diagnoses and treat the emergent patient in a prehospital setting.
Objectives: Upon completion of learning activities, participation in lecture/discussion, and clinical
activities, the student will be provided the opportunity to:
1. Indentify the risk factors most predisposing to diseases of the nervous system.
2. Discuss the anatomy and physiology of the nervous system.
3. Define and discuss the epidemiology, Pathophysiology, assessment finding, and management for the
following neurologic problems:
a. Coma and altered mental status.
b. Seizures.
c. Syncope.
d. Headache.
e. Neoplasms.
f. Abscess.
g. Stroke.
h. Intracranial hemorrhage.
i. Transient ischemic attack.
j. Degenerative neurological diseases.
4. Describe and differentiate the major types of seizures.
5. Describe the phases of a generalized seizure.
6. Define the following:
a. Muscular dystrophy.
b. Multiple sclerosis.
c. Dystonia.
d. Parkinson’s disease.
e. Trigeminal neuralgia.
f. Bell’s palsy.
g. Amyotrophic lateral sclerosis.
h. Peripheral neuropathy.
i. Myoclonus.
j. Spina bifida.
k. Poliomyelitis.
Clinical Laboratory Objectives with Calendar/Schedule.
Rational: Psychomotor implementation of learned cognitive and affective didactic content is a necessary
component in assuring that the participant has integrated learned material.
Objectives: The Paramedic student will demonstrate competency in the clinical laboratory by meeting the
following objectives:
1. Attendance at all scheduled demonstration and practice labs as assigned.
2. Demonstrate professional behavior, judgment, and attitude toward instructor, peers, and
colleagues while in the clinical laboratory consistent with the affective domain behavioral
objectives to include: Integrity, Empathy, Self-Motivation, Appearance and Personal Hygiene,
Self-Confidence, Communications, Time Management, Teamwork and Diplomacy, respect,
Patient Advocacy, and Careful Delivery of Service. Refer to the Performance Affective Domain
Evaluation (PADE).
3. Successful demonstration of clinical skills validation consistent with the psychomotor domain, by
the third attempt of the following skills (Refer to Clinical Skills Evaluation Tools):
4. Successful performance of the Program Critical Performance Evaluation #2: ACLS Strip
Recognition.
Unit Clinical Skill Lab Objectives:
Chapter 27: Pulmonology
1. The student will demonstrate and successfully perform Pulse Oximerty. (p. 463)
2. The student will demonstrate and successfully perform CPAP. (p.463)
3. The student will demonstrate and successfully perform Colorimetric Devices. (p.464)
Chapter 28: Cardiology
1. The student will successfully perform ECG Rhythm Interpretation. (pp. 1133-1185)
2. The student will successfully perform ECG Monitoring.(pp. 1196-1197)
3. The student will demonstrate and successfully perform Pericardial Thump. (p.1109)
4. The student will demonstrate and successfully perform Defibrillation. (1202-1203)
5. The student will demonstrate and successfully perform Synchronized Cardioversion.(p.1202)
6. The student will demonstrate and successfully perform External Cardiac Pacing. (pp.1207-1208).
7. The student will demonstrate and successfully perform Carotid Sinus Massage. (pp.1209-!210)
8. The student will demonstrate and successfully perform a Mega Code.
9. The student will demonstrate and successfully perform 12-lead ECG Monitoring. (pp.12371239)
Chapter 29: Neurology
1. The student will demonstrate and successfully perform a Neuro Assessment.
Course Policies:
Grades:
Students are expected to maintain a minimum grade of 80% or C or better in the course for satisfactory
completion of the course and progression in the Paramedic Program.
Exams:
Exams are scheduled at the discretion of the faculty, and are usually given after completion of each unit
The student must be present during the time of the exam, there are no makeup exams.
If the student is late they will be required to schedule a make-up with the instructor.
A comprehensive final exam must be taken.
Assignments are due at the start of class on the assigned due date.
Exams are scheduled at the discretion of the faculty, and are usually given after completion of each unit
The student must be present during the time of the exam, there are no makeup exams.
If the student is late they will be required to schedule a make-up with the instructor.
A comprehensive final exam must be taken.
Assignments are due at the start of class on the assigned due date.
Late Work and Make-up Policy:
There will be no make-up exams or quizzes.
Extra Credit Policy:
Typically no extra credit assignments are given
Grades of "Incomplete":
The current College policy concerning incomplete grades will be followed in this course. Incomplete
grades are given only in situations where unexpected emergencies prevent a student from completing the
course and the remaining work can be completed the next semester. Your instructor is the final authority
on whether you qualify for an incomplete. Incomplete work must be finished by the end of the
subsequent semester or the “I” will automatically be recorded as an “F” on your transcript.
The Paramedic policy does not allow for incomplete grades in this course due to prerequisite
requirements. The student must be able to meet the objectives of this course in order to move on in the
curriculum path.
Course Policies: Technology and Media
Email: Arkansas Northeastern College has partnered with Google to host email addresses for ANC
students. myANC mail accounts are created for each student enrolled in the current semester and is the
email address your instructor will use to communicate with you. Access your email account by going to
http://mail.google.com/a/smail.anc.edu and using your first and last names, separated by a period for
your username. Your default password is the last six digits of your Student ID. If you cannot access your
student email, contact the MITS department at 762-1020 ext 1150 or ext 1207 or send an email to
[email protected].
E-mail access is made available to all students enrolled in the course. Faculty will use e-mail through
myANC to contact students regarding any messages that must be disseminated when not in class or
clinical. Faculty will check his/her e-mail on evenings and weekends. Students are also encouraged to
check their e-mail for messages on a regular basis.
Internet: This course has a web component on myANC, students are encouraged to login to their myANC
everyday as assignments for this course may be posted.
Laptop Usage: Laptops are typically not used within this course. If a student requests use of a laptop for
taking notes during lecture, the situation will be assessed on an individual basis.
Classroom Devices: Tape recorders or other audio and technology devices are allowed as long as they are
not disturbing to other students.
Computer Labs: In addition to general-purpose classrooms, a number of computer laboratories are
provided for instructional and student use. These networked laboratories are state-of-the-art and fully
equipped with computers, printers, Internet connections and the latest software. The labs are open to
students enrolled in one or more credit hours at the College.
The Burdette Center has a well-equipped computer lab in the Nursing building that is made available to
students Monday through Friday 7:00 am until 5:00pm.
Technology Support: A lab assistant is generally present in the computer lab in B202 for assistance in
using the College computers. These assistants cannot help you with course assignments; specific
questions regarding the technology requirements for each course should be directed to the instructor of
the course. Problems with myANC or College email accounts should be addressed by email to
[email protected].
Course Policies: Student Expectations:
Disability Access: Arkansas Northeastern College is committed to providing reasonable accommodations
for all persons with disabilities. This First Day Handout is available in alternate formats upon request.
Students with disabilities who need accommodations in this course must contact the instructor at the
beginning of the semester to discuss needed accommodations. No accommodations will be provided until
the student has met with the instructor to request accommodations. Students who need
accommodations must be registered with Dr. Blanche Sanders or Suzanne Robinson at the Learning
Assistance Center, Room L104.
Attendance Policy:
Daily attendance records are maintained. It is in the best interests of the student to attend all classes.
Considering importance of content mastery all clinical hours must be attended. If a student misses more
than three classes a mandatory counseling session regarding absenteeism and the viability of course
continuation will be required.
Professionalism Policy:
Students are expected to attend all classes, be on time, and remain in class for the scheduled length of time.
Students are expected to exhibit professional behaviors in the class, clinical labs, and during clinical site
rotations. Mobile phones, iPods, etc. must be silenced during all classes and clinical labs. No mobile phones
or electronic devices are permitted at clinical site locations during clinical rotations.
Academic Conduct Policy:
Academic dishonesty in any form will not be tolerated. If you are uncertain as to what constitutes academic
dishonesty, please consult ANC’s Student Handbook (http://www.anc.edu/docs/anc_handbook.pdf) for
further details. Students are expected to do their own work. Plagiarism, using the words of others without
express permission or proper citation, will not be tolerated. Any cheating (giving or receiving) or other
dishonest activity will, at a minimum, result in a zero on that test or assignment and may be referred, at the
discretion of the instructor, to the Department Chair and/or Vice President of Instruction for further action.
Cheating on a test or other assignment is grounds for disciplinary action and the student may be dismissed
immediately from this course and the entire program. Studying together is acceptable and encouraged
because such can be helpful in learning; but each class member is expected to prepare his/her own class
assignments based on his/her knowledge and individual effort.
Learning Assistance Center:
The Learning Assistance Center (LAC) is a free resource for ANC students. The LAC provides drop-in
assistance, computer tutorials and audio/visual aids to students who need help in academic areas. Learning
labs offer individualized instruction in the areas of mathematics, reading, writing, vocabulary development
and college study methods. Tutorial services are available on an individual basis for those having difficulty
with instructional materials. The LAC also maintains a shelf of free materials addressing specific problems,
such as procedures for writing essays and term papers, punctuation reviews, and other useful materials. For
more information, visit the LAC website at http://www.anc.edu/LAC or stop by room L104 in the
Adams/Vines Library Complex.
Other Student Support Services:
Many departments are ready to assist you reach your educational goals. Be sure to check with your advisor;
the Learning Assistance Center, Room L104; Student Support Services, Room S145; and Student Success,
Room L101 to find the right type of support for you.
Basis for Final Grade:
The final grade will be based on unit exams (60%), and Final Exam (25%). Other assignments (15%) will not
be calculated into the grade unless the averaged Unit Exams and Final Exams is an 80% or greater. In
addition, students must successfully validate all assigned skills by the third attempt to meet clinical
objectives and requirements to pass the course.
Assessment
Percent of Final Grade
Unit Exams
Assigned Class Work
Final Exam
50%
15%
25%
100%
Grading Scale (%)
91 – 100
85 – 90
A
B
80 – 84
70 – 79
0 – 70
C
D
F
Grade Dissemination:
Graded unit exams will be returned to the student for review of grade and questions missed. The instructor
will review each exam and answer any questions the student may have in relation to the exam.
Mid-term grades are issued to students in the fall and spring semesters to inform them of progress in their
courses. The mid-term grades are temporary grades and are not recorded on the student academic record.
A counseling session will be held with every student to discuss mid-term grades. Mid-tem and final grades
can be accessed using Campus Connect on myANC. Please note that scores returned mid-term are
unofficial grades. If you need help accessing myANC contact the ANC Helpdesk by email:
[email protected]. Final grades will be issued to all students at the end of each semester or the final
summer session. The final grades are permanent grades and will be recorded on the student academic
records. Inquiries concerning grades should be referred to the Register’s Office.