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Test Bank Paramedic Care Principles & Practice, Vols. 2 5th Edition by Bryan Bledsoe

MASTER TEACHING NOTES

Detailed Lesson Plan Chapter 1 Scene Size-Up 80–85 Minutes

• • • •

Teaching Tips Discussion Topics Critical Thinking Questions Class Activities

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 I.

Case Study

Master Teaching Notes Teaching Tips Have a student read the scenario. Tell students the case will be reviewed after the lecture.

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 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

Teaching Tips Remember that an injured medic is a hindrance, and a dead medic is useless.

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.

Test Bank Paramedic Care Principles & Practice, Vols. 2 5th Edition by Bryan Bledsoe

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

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

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

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.

With students, compile a list of resources that might be needed on an EMS scene.

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.).

Test Bank Paramedic Care Principles & Practice, Vols. 2 5th Edition by Bryan Bledsoe

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 15

Content Outline 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

Master Teaching Notes 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.

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 IX. Case Study

Class Activities Discuss the case with students now that they are familiar with the chapter.

X. You Make the Call 5

Class Activities Read and discuss the call and questions as a group.

Test Bank Paramedic Care Principles & Practice, Vols. 2 5th Edition by Bryan Bledsoe

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 XI. Review Questions

Master Teaching Notes 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.

Test Bank Paramedic Care Principles & Practice, Vols. 2 5th Edition by Bryan Bledsoe

MASTER TEACHING NOTES

Detailed Lesson Plan Chapter 2 Primary Assessment 100–105 Minutes

• • • • •

Teaching Tips Discussion Topics Class Activities Points to Emphasize Knowledge Application

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 I.

Case Study

Master Teaching Notes Teaching Tips Have a student read the scenario. Tell students the case will be reviewed after the lecture.

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

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

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

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. 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.

Discuss with students different stimuli that are used to determine AVPU.

Test Bank Paramedic Care Principles & Practice, Vols. 2 5th Edition by Bryan Bledsoe

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.

Test Bank Paramedic Care Principles & Practice, Vols. 2 5th Edition by Bryan Bledsoe

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 15

Content Outline

Master Teaching Notes

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

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

Discuss with students the different breathing patterns, including agonal, Cheyne-Stokes, Biot’s, hyperventilation, tachypnea, bradypnea, etc.

Have students find the various pulses on each other.

Test Bank Paramedic Care Principles & Practice, Vols. 2 5th Edition by Bryan Bledsoe

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

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.

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.

Test Bank Paramedic Care Principles & Practice, Vols. 2 5th Edition by Bryan Bledsoe

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 X.

Case Study

Master Teaching Notes Class Activities Discuss the case with students now that they are familiar with the chapter.

XI. You Make the Call 5

Class Activities Read and discuss the call and questions as a group.

XII. Review Questions 5

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.

Test Bank Paramedic Care Principles & Practice, Vols. 2 5th Edition by Bryan Bledsoe

MASTER TEACHING NOTES

Detailed Lesson Plan Chapter 3 Therapeutic Communications 90–100 Minutes

• • • •

Teaching Tips Discussion Topics Class Activities Points to Emphasize

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 I.

Case Study

Master Teaching Notes Teaching Tips Have a student read the scenario. Tell students the case will be reviewed after the lecture.

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

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

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.).

With students, discuss each way you can build trust, and how not building a rapport can impede patient care

Test Bank Paramedic Care Principles & Practice, Vols. 2 5th Edition by Bryan Bledsoe

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 4. 5. 6. 7. 8.

Master Teaching Notes

Modulate your voice Use professional but compassionate tone of voice Explain what you are doing and why Keep a kind, calm facial expression Use appropriate style of communication

Class Activities

IV. Effective Communication Techniques A. Guidelines to effective communication include consistent professionalism, nonjudgmental attitude, and willingness to talk about a concern B. Nonverbal communication: 1. Body Language a. Distance – intimate space is less than 1.5 ft, and comfortable distance is twice the length of patient’s arm 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. Stance – your stance sends a message to the patient 1. An open stance – arms extended, open hands, relaxed large muscles, and nodding head – 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

Interviewing a Patient

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 Have students interview each other using various degrees of distance, eye contact, and stance.

Points to Emphasize 2

Test Bank Paramedic Care Principles & Practice, Vols. 2 5th Edition by Bryan Bledsoe

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. 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 B. Active Listening 1. The art of listening well is a trait few people practice 2. Listening is crucial for a skilled clinician, as you will learn valuable information about your patient 3. Development of good communication skills takes time and practice 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 he feels about what he is experiencing i. Explanation – sharing facts and objective information j. Summarization – reviewing the interview 5. Several practices are “traps of interviewing” or common errors that can hinder the patient interview a. Providing false assurances

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.

Test Bank Paramedic Care Principles & Practice, Vols. 2 5th Edition by Bryan Bledsoe

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

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 C. Observing Your Patient 1. Look at external signs during your patient interview that can give you indication of your patient’s condition 2. Observe level of consciousness, body movements, mood, energy level, eye contact, and behavior D. Using Appropriate Language 1. Refrain from sophisticated medical terminology 2. Obstacles include cultural differences, language, deafness, speech impediments, and blindness 20

VI. Special Needs and Challenges A. Most patients are more than willing to answer questions B. Some patients may require more time and various techniques to establish rapport and wiliness to answer questions C. Some patients you encounter will have different communication needs 1. Children a. Talk to the caregivers b. Get down to their eye level and stay calm c. Talk to children and answer their questions honestly, and most importantly, build trust 2. Elderly Patients a. Be respectful and courteous b. Allow the patients time to talk and answer questions c. Use compassionate touch 3. Patients with Sensory Impairment a. Blind, sight-impaired, deaf, or hearing-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 communication technique to accommodate the patient’s needs

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.

Test Bank Paramedic Care Principles & Practice, Vols. 2 5th Edition by Bryan Bledsoe

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. Angry, Hostile, or Uncooperative Patients a. Set limits and establish boundaries with hostile patients to maintain scene safety b. Avoid confrontation 5. Sensitive Topics a. Remain calm, objective, and nonjudgmental when questioning a patient about a sensitive subject b. Let the patient know that what he tells you is confidential information 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 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 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 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 10. Patients Needing Reassurance a. Listen to your patient before offering reassurance 11. Intoxicated Patients a. Scene safety is most important b. Avoid judgment, confrontation, etc. 12. Crying Patients a. Accept that crying may be a normal response for your patient 13. Depressed Patients ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 2, 5th Ed.

Test Bank Paramedic Care Principles & Practice, Vols. 2 5th Edition by Bryan Bledsoe

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. Determine that your patient is not suicidal 14. Patients with Confusing Behaviors or Histories a. Focus assessment on patient’s mental status (thought, perceptions, mood) b. Differentiate between delirium and dementia, if possible 15. Patients with Limited Intelligence a. Do not assume that your patient will not be able to give you his medical history, or tell you what his complaint is b. Show compassion and patience c. If a patient has mental retardation that impedes his communication abilities, use the family/caregiver or friends 16. Talking with Family or Friends a. Use family and friends when encountering a patient who is unable to give you any information b. Patient confidentiality is always a priority, even when using family and friends 5

VII. Transferring Patient Care A. Using correct communication techniques allows for proper patient transfers between medical professionals 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.

VIII. Summary A. To provide the best care, you must be able to quickly and effectively gather information about the patient B. Pay attention to your body language, tone of voice, facial expressions, and personal space C. Showing compassion and empathy will allow you to become an ally to your patients and others IX. Case Study

Class Activities Discuss the case with students now that they are familiar with the chapter.

Test Bank Paramedic Care Principles & Practice, Vols. 2 5th Edition by Bryan Bledsoe

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 X. You Make the Call

Master Teaching Notes Class Activities Read and discuss the call and questions as a group.

XI. Review Questions 5