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Airway Management and Suctioning

  • Aim to limit suctioning to a maximum of 15 seconds in adults, only suction during withdrawal.
  • Do not exceed the base of the tongue when suctioning the airway.

Choking Response Protocol

  • Treatment for Conscious Children (Over 1 Year):
    • Five back blows.
    • If ineffective, proceed with five abdominal thrusts.
  • Treatment for Infants:
    • Five back blows followed by five chest thrusts.
  • If the infant becomes unresponsive:
    • Initiate CPR, checking the airway prior to delivering ventilations.

Anaphylaxis Scenario

  • Case Example:
    • 32-year-old female, out running, stung by a bee.
    • Allergic to bees, presents with flushed skin, itchy sensation, and stridor sounds from the airway.
Capillary Refill Time Assessment
  • Decreased capillary refill time expected in anaphylaxis due to blood vessel dilation.
  • Flushed appearance indicates dilated blood vessels; pale, cool, diaphoretic skin indicates a prolonged capillary refill time.

Medication in Anaphylaxis

  • Drug for Anaphylactic Reaction:
    • Epinephrine:
    • Acts as a bronchodilator and vasoconstrictor.
    • Mimics adrenaline produced by adrenal glands due to histamine release.
Primary Assessment (Primary Survey) Components

  • Obtain SpO2 and respiratory rate during assessment.

  • Assess:

    • Rate (Is it fast or slow?)
    • Regularity (Is it regular or irregular?)
    • Chest rise (Visible chest rise indicates adequate breathing).

  • Patient Parameters: Example:

    • Respiratory Rate: 22 breaths per minute (labored, but adequate tidal volume).
    • SpO2 on room air: 89%.

  • High-flow oxygen delivery systems:

    • % delivered by non-rebreather mask: Could be up to 100% if inflated (depending on seal).
    • Flow rate for non-rebreather: 10-15 L/min, for nasal cannula: 1-6 L/min.
Oxygen Administration Guidelines
  • Target SpO2 for patients with:
    • Stridor and low oxygen: Use a non-rebreather mask.
    • Cardiac chest pain (SpO2 of 89% without breathing issues): Use nasal cannula (target SpO2 is max 90%).
  • High flow oxygen is necessary for patients in respiratory distress, especially with stridor.
Assessing Adequate vs. Inadequate Breathing
  • Inadequate breathing requires positive pressure ventilation (PPV).
  • Delivery method for PPV: BVM (Bag-Valve-Mask) at 15 L/min.
Airway Assessment
  • Evaluate breathing parameters:
    • Number of breaths/minute (normal ranges): Adult 8-24, Child 18-30, Infant 30-60 breaths/min.
    • Assess tidal volume by observing chest rise (acceptable rise: 1 inch for adults).
Important Terms:
  • Labored Breathing: Increased work of breathing without adequate tidal volume.
  • Visible Chest Rise: Indicates adequate respiration quality.
  • Tidal Volume: Volume of air inhaled/exhaled during normal breathing.

Signs of Shock and Vital Signs Evaluation

  • Assessment of Circulation:
    • Assess pulse: location according to age (radial for conscious adults, carotid for unresponsive patients).
    • Evaluate skin color (pale, flushed) to understand capillary refill time.
  • Threshold for capillary refill time:
    • Adult males: 2 seconds; children: less than 2 seconds; females: less than 3 seconds; elderly: less than 4 seconds.
Recognizing Shock:
  • If patient exhibits pale skin with low capillary refill, suspect possible shock.
CPR and AED Usage
  • AED Conditions: Use AED for unresponsive patients with no pulse.
    • Identify rhythms for CPR: Vfib (never with pulse), Vtach (may present with pulse but can become pulseless).
  • Non-shockable rhythms include:
    • Asystole: Flat line; no electrical or mechanical activity.
    • Pulseless Electrical Activity (PEA): Electrical activity without pulse.
Vital Signs Measurement Instructions
  • Document pulse accurately (rate, rhythm, quality, and site).
    • Count for 30 seconds; multiply by 2 for pulse estimates unless irregular (which requires counting a full minute).
Vital Signs Assessment Parameters:
  • Blood pressure, pulse characteristics (weak, thready, or bounding), respiratory rate, and quality.
  • Utilize the terms:
    • Bradycardia: Slow pulse rate (
Skin Assessment and Skin Signs Mapping
  • Evaluate skin for:
    • Temperature: Warm/cool, Dry/clammy (clammy signifies possible shock).
  • Assess skin color:
    • Normal: Pink; Pale: Shock; Flushed: Vasodilation.
Pupillary Response Assessment
  • Pupil Assessment: Check for size and reaction to light (PEARL: Pupils Equal And Reactive to Light).
Documentation Guidelines
  • Complete a documentation form detailing:
    • Time of vital signs, blood pressure, heart rate, respiratory rate, and skin condition.
  • Use I.V. and radio communication terminologies correctly during patient transportation.

This comprehensive protocol and assessment guide serves as an exhaustive resource for student EMTs, covering critical airway management, response protocols for choking and anaphylaxis, vital signs assessment, and documentation processes.