1. Chapter 21: Supplemental Skills

2. Knowledge and Attitude Objectives 1.Describe how to measure blood pressure by palpation. 2.Describe how to measure blood pressure by auscultation. 3.Describe the indications for using supplemental oxygen. 4.Describe the equipment used to administer oxygen. (1 of 2)

3. Knowledge and Attitude Objectives 5.Describe the safety considerations and hazards of oxygen administration. 6.Explain the benefit of automated external defibrillation in the Cardiac Chain of Survival. 7.Describe the indications and use of a bag-mask device. 8.Describe the function and operation of a pulse oximeter. (2 of 2)

4. Skill Objectives 1.Measure blood pressure by palpation. 2.Measure blood pressure by auscultation. 3.Assemble the equipment used to administer oxygen. (1 of 2)

5. Skill Objectives 4.Administer supplemental oxygen using a nasal cannula and a nonrebreathing mask. 5.Perform bag-mask ventilation. 6.Perform pulse oximetry. (2 of 2)

6. Supplemental Skills Skills include: –Taking blood pressure –Administering supplemental oxygen –Assessing the level of oxygen in the blood

7. Blood Pressure Systolic –Force exerted on walls of arteries during contraction Diastolic –Arterial pressure during relaxation phase of heart

8. Blood Pressure Disorders Hypertension (high blood pressure) –Exists when blood pressure is greater than 146/96 Hypotension (low blood pressure) –Exists when systolic pressure falls to 90 or below

9. Taking Blood Pressure by Palpation Apply blood pressure cuff above crease of elbow. With fingers, not thumb, locate brachial pulse. Inflate cuff 30 mm past where you no longer feel pulse. Slowly release pressure. Feel for return of pulse—systolic.

10. Taking Blood Pressure by Auscultation Apply blood pressure cuff above crease of elbow. Place stethoscope over brachial artery. Inflate cuff 30 mm past where sound disappears. Slowly release pressure. Listen for pulse to return—systolic. Listen for pulse to disappear—diastolic.

11. Oxygen Administration Supplemental oxygen is beneficial to patients suffering from: –Shock –Heart attack –Stroke –Chronic heart and lung disease

12. Oxygen Equipment Oxygen cylinder Pressure regulator/ flowmeter Nasal cannulas and face masks

13. Oxygen Administration Equipment Nasal cannulaNonrebreathing mask

14. Safety Considerations Oxygen actively supports combustion. –Never permit smoking around oxygen equipment. Pressurized cylinders can cause explosion if damaged.

15. Bag-Mask Device Self-inflating bag One-way valves Face mask (1 of 2)

16. Bag-Mask Device Advantage: Supplies up to 90% oxygen to patient Disadvantage: Hard for one person to maintain a seal (2 of 2)

17. Pulse Oximetry Used to assess amount of oxygen saturated in red blood cells Sensing probe attaches to patient’s fingertip or earlobe. Cannot tell you what is wrong but can help you recognize that a problem exists (1 of 2)

18. Pulse Oximetry Will not give accurate reading if patient: –Is wearing nail polish or if fingers are dirty –Is cold –Has lost a lot of blood –Is suffering from carbon monoxide poisoning (2 of 2)

19. Assisting Other EMS Providers Being able to assist other EMS providers can improve patient care. Master additional skills that are permitted by your local protocols, medical director, and state regulations.