Prehospitalt arbeid modul 1 – Transportmedisin, luftveishåndtering og sirkulasjonssvikt.
2014-2015 - K1189 - 5sp

Forventet læringsutbytte

Kunnskap

  • Kandidaten;
    • kan gjøre rede for luftveishåndtering, oksygenbehandling og ventilering av pasienter prehospitalt på avansert nivå
    • har avansert kunnskap om hjerte-lungeredning , sjokk- og væskebehandling prehospitalt
    • viser innsikt i spesielle utfordringer ved transportmedisin
    • viser innsikt i bruk av medisinsk teknisk utstyr, monitorering og sikkerhet i ambulansetjenesten
    • har kunnskap om kommunikasjon og samhandling prehospitalt
    • har kunnskap om juridiske rammer og etiske utfordringer og kan vurdere problemstillinger i grenselandet mellom etikk og jus i prehospitalt arbeid

Ferdigheter

  • Kandidaten kan på en forsvarlig måte;
    • anvende utstyr og ulike teknikker for luftveishåndtering, oksygenering og ventilering av pasienter prehospitalt
    • utføre korrekt væskebehandling prehospitalt
    • benytte medisinsk teknisk utstyr i ambulansen
    • utføre hjerte-lungredning etter gjeldende retningslinjer
    • kommunisere og samarbeide med ambulansepersonell, leger og annet personell prehospitalt

Generell kompetanse

  • Kandidaten;
    • erkjenner de spesielle rammene innen transportmedisin, luftveishåndtering og sirkulasjonssvikt prehospitalt
    • kan anvende kunnskaper og ferdigheter innenfor transportmedisin, luftveishåndtering og sirkulasjonssvikt i prehospitalt arbeid
    • kan begrunne valg ut fra juridiske og etiske rammer innen området transportmedisin, luftveishåndtering og sirkulasjonssvikt.
    • forstår betydningen av å jobbe i team
    • kan jobbe kunnskapsbasert 

Emnets temaer

  • Luftveishåndtering prehospitalt
  • Ventilering prehospitalt (manuell og ventilator)
  • Oksygenbehandling
  • Monitorering og overvåkning
  • HLR/DHLR/AHLR, spesielle HLR situasjoner, hjelpemidler ved HLR – barn/voksne
  • Sirkulasjonssvikt og væskeresuscitering
  • Medikamenter prehospitalt
  • Forberedelse til transport (medikamenter, utstyr osv.)
  • Utstyr i ambulansen
  • Sikkerhet (pasient, personell og utstyr)
  • Transportkuvøser, ventilator, sprøytepumper osv.
  • Forholdsregler ved ulike sykdomstilstander
  • Forflytningsteknikk
  • Etikk og jus

Pedagogiske metoder

Annet

Pedagogiske metoder (fritekst)

  • Simulering
  • Forelesning
  • Selvstudie

Vurderingsformer

Annet

Vurderingsformer

  • Deleksamen – flervalgstest
  • Deleksamen – tester av praktiske ferdigheter og simulering
  • Begge deler må være bestått

Karakterskala

Bestått/Ikke bestått

Sensorordning

Flervalgstest – sensureres av én intern sensor
Simulering/ferdighetstest – sensureres av to interne sensorer

Utsatt eksamen (tidl. kontinuasjon)

Flervalgstest – gjennomføre ny flervalgstest i inneværende  semester
Simulering/ferdighetstest – gjennomføring av ny test i inneværende semester

Tillatte hjelpemidler (gjelder kun skriftlig eksamen)

Flervalgstest: Alle hjelpemidler er tillatt.
Simulering og tester: Utleverte hjelpemidler er tillatt.

Obligatoriske arbeidskrav

  • Innlevering av en problemstilling til diskusjon i plenum – Godkjent/ikke godkjent
  • Deltakelse på samlinger (minimum 80%)

Læremidler

Obligatorisk litteratur
Sanders, M J (2010). Sanders’ Paramedic Textbook. (First published 2010) UK: Elsevier Limited
Kap. 4: Approaches to Assessment
Kap. 6: Therapeutic Communication
Kap. 7: Patient Assessment
Kap. 8: History Taking
Kap. 9: Techniques of Physical Examination
Kap.10: Differential Impressions and Clinical Decision Making
Kap. 12: Pharmacology, venous access and drug administration
Kap. 13: Airway Management and Ventilation
Kap. 14: Respiratory Emergencies
Kap. 15: Cardiology
Kap. 16: Neurology
Kap. 18: Allergies and Anaphylaxis
Kap. 21: Toxicology
Kap. 23: Environmental Conditions
Kap. 28: Haemorrhage and Shock
Kap. 37: Care of the Newborn
Kap. 38: Pediatrics
Kap. 39: Older Persons
Kap. 44: Crime Scene Awarness   

Nordby, H (2010). Etikk og kommunikasjon – I prehospitalt medisinsk arbeid. Norge: Gyldendal Norsk Forlag AS
Kap. 3:  Etiske metodeverktøy
Kap. 4:  Etiske teorier
Kap. 5:  Etikk, medisin og juss
Kap. 6:  Praktisk kommunikasjon

Om norske retningslinjer – 2010
BHLR retningslinjer – 2010
DHLR retningslinjer – 2010
Fremmedlegeme retningslinjer – 2010
AHLR retningslinjer – 2010
Barn retningslinjer – 2010
Nyfødt retningslinjer – 2011
Hvorfor er AHLR algoritmen annerledes i Norge

Berlac, P, Hyldmo, P K, Kongstad, P, Kurola, J, Nakstad, A R, Sandberg, M (2008) Pre-hospital airway management: guidelines from a task force from Scandinavian Society for Anaesthesiology and Intensiv Care Medicine. Acta Anaesthesiol Scand 2008; 52: 897-907

Braude, D, Richards, M (2007) Rapid Sequence Airway (RSA) – A Novel Approach To Prehospital Airway Management. Prehospital Emergency Care. 11:2, 250 – 252

Busch, M, Søreide E (2008) Prognostication after out-of-hospital cardiac arrest, a clinical survey. Scandinavnian Journal of Trauma, Resuscitation and Eergency Medicine16:9,doi:10.1186/1757-7241-16-9

Carr, B G, Bracchet, David, G, Duseja, R, Branas, C C (2008) The Time Cost of Prehospital Intubation and Intravenous Access in Trauma Patients. Prehsopital Emergency Care 12:3, 327 – 332

Christensen, E F, Høyer, C C S (2003) Prehsopital tracheal intubation in severely injured patients: a Danish observational study. BMJ 2003; 327; 533-534

Cole, C D, Wang, H E, Abo, B N, Yealy, D M (2006) Drug-Assisted Effects on Protective Airway Reflexes During Out-of-Hospital Endotracheal Intubation (Preliminary Report). Prehospital Emergency Care 10:4, 472 – 47

Elliot, E, Kiran, A (2006) Accidental hypothermia. BMJ 2006; 332; 706 – 709

Hoyle, J D, Jones, J S, Deibel, M, Lock, D T, Reischmann, D (2007) Comparative Study of Airway Management Techniques with Restricted Access to Patient Airway. Prehsoptial Emergency Care 2007; 11:330 – 336

Izsak, E, Moore, Janet L, Stringfellow, K, Oswanski, M F, Lindstrøm, D A, Stombaugh, H A (2008) Prehospital Pain Assessment in Pediatric Trauma. Prehospital Emergency Care, 12:2, 182 – 186

Krauss, B, Nagler, J (2008) Capnography: A Valuable Tool for Airway Management. Emerg Med Clin N Am 26 (2008) 881-897

McCall, M J, Reeves, M, Skinner, M, Ginifer, C, Myles, P, Dalwood, N (2008) Paramedic Tracheal Intuabtion Using the Intubating Laryngeal Mask Airway. Prehospital Emergency Care 12:1, 30 – 34

Nordby, H, Nøhr, Ø (2008) Communication and empathy in an emergency setting involving persons in crisis. Scandinavnian Journal of Trauma, Resuscitation and Emeregncy Medicine 2008, 16:5 doi:10.1186/1757-7241-16-5

Paal, P, Herff, H, Mitterlechner, T, Von Goedecke, A, Brugger, H, Lindner, K H, Wenzel, V (2009) Anaesthesia in prehospital emergencies and in the emergency room. Resuscitation. Doi:10.1016/j.resuscitation.2009.10.023

Taylor, D McD, Bernard, S A, Masci, K, MacBean, C E, Kennedy, M P (2008) Prehospital Noninvasive Ventilation: A Viable Treatment Option in the Urban Setting. Prehospital
Emergency Care, 12:1, 42 – 45

Helsebiblioteket – forgiftninger
http://www.helsebiblioteket.no/Forgiftninger

http://www.helsebiblioteket.no/Forgiftninger/Antidoter

http://www.helsebiblioteket.no/Forgiftninger/Rusmidler

http://www.helsebiblioteket.no/Forgiftninger/Brekningsfremkalling

http://www.helsebiblioteket.no/Forgiftninger/Kull

Anbefalt litteratur
ALNSF (2006).Idegrunnlag og funksjonsbeskrivelse for anestesisykepleiere.  
http://www.alnsf.no

Berlac, P A, Wammen, S, Giebner, M, Thomsen, A B, Mikkelsen, S (2010) Vejledning ved ambulansetransport Ugeskrift Læger 172/17

Bérubé, M, Bernard, F, Marion, H, Parent, J, Thibault, M, Williamson, D R, Albert, M (2012) Impact of a preventive programme on the occurence of incidents during the transport of critically ill patients Intensive and Critical Care Nursing (2012)

Brice, J H, Studnek, J R, Bigham, B L, Martin-Gill, C, Custalow, C B, Hawkins, E, Morrison, L J (2012) EMS provider and patient safety during response and transport: proceedings of an ambulance safety conference. Prehospital Emergency Care 2012, volume 16, number 1: 1-19

Crocco, T J, Grotta, J C, Jauch, E C, Kasner, S E, Kothari R U, Lamon,  R, Saver, J L, Sayre, M R, Davis, S M (2007) EMS Management of Acute Stroke – Prehospital Triage. Prehospital Emergency Care 11:3, 313 – 317

Dalton, Limmer, Mistovich, Werman . (2006) Advanced Medical Life Support. (3 rev ed) USA. Pearson Education US

Davis, D P, Hwang, J Q, Dunford, J V (2008) Rate of Decline in Oxygen Saturation at Various Puls Oximetry Values with Prehospital Rapid Sequence Intubation. Prehospital Emegency Care 12:1, 46 – 51

Deakin, C D, Clarke, T, Nolan, J et al (2010) Liaison Committee Airway Working Group, care: Joint Royal Colleges Ambulance service airway management in prehospital A critical reassessment of ambulance. Emerg Med J 2010; 27:226-233

Donald, M J, Paterson, B (2006) End tidal carbon dioxide monitorering in prehospital and retrieval medicine: a review. Emerg Med J 2006;23:728-73

Doyle, G S, Taillac, P P (2008) Tourniquets: A Review of Current Use with Proposals for Expanded Prehospital Use. Prehospital Emergency Care 12:2, 241 – 256

Frascone, R J, Jensen J P, Kaye, K, Salzman, J G (2006) Consecutive Field Trials Using Two Different Intraosseus Devices. Prehospital Emergency Care 2007;11:164-171

Friberg, H (2008) Neurological prognostication after cardiac arrest. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2008

Garza, A G, Gratton, M C, McElroy, J, Lindholm, D, Coontz, D (2008) Environmental Factors Encountered During Out-of-Hospital Intubation Attemps. Prehospital Emergency Care, 12:3, 286 – 289

Genzwuerker, H V (2008) Prehospital airway management: the patient needs oxygen! Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2008, 16:3 doi:10.1186/1757-7241-16-3

Heradstveit, Bård E, Sunde, Kjetil, Sunde, Geir-Arne, Wentzel-Larsen, Tore, Heltne, Jon-Kenneth (2012) Factors complicating interpretation of capnography during advanced life support in cardiac arrest – a clinical retrospective study in 575 patients. Resuscitation, volume 83, Issue 7, July 2012, Pages 813-818

Hirabayashi Y, Seo, N (2009) Airtraq optical laryngoscope: tracheal intubation by novice laryngoscopists. Emerg. Med. J. 2009;26;112-113

Hubble, M W, Richards, M E, Jarvis, R, Millikan, T, Young, D (2006) Effectiveness of Prehospital Continius Positive Airway Pressure in the Management of Acute Pulmonary Edema. Prehospital Emergency Care   10:4, 430 – 439.

Lov 1999-07-02 nr 61: Lov om spesialisthelsetjenesten m. m.
http://www.lovdata.no/all/nl-19990702-061.html

Lov 1999-07-02 nr 63: Lov om pasientrettigheter  
http://www.lovdata.no/all/nl-19990702-063.html

Lov 1999-07-02 nr 64: Lov om helsepersonell m.v.
http://www.lovdata.no/all/nl-19990702-064.html

Martin, T (2012) Transporting the adult critically ill patient Surgery (Oxford) Volume 30, Issue 5, May 2012, pages 219-224.

Melby, Vidar, Ryan, Assumpta (2005) Caring for older people in prehospital emergency care: can nurses make a difference? Journal of Clinical Nursing 2005; Volume 14, Issue 9, pages 1141-1150

Millin, M G, Gullett, T, Daya, M (2007) EMS Management of Acute Stroke – Out-of-Hospital Treatment and Stroke System Development. Prehospital Emeregncy Care 11:3, 318 – 325

Parwani, V, Hoffman, R J, Russel, A, Bharel, C, Preblick, C, Hahn, I  (2007) Practicing Paramedics Cannot Generate or Estimate Safe Endotracheal Tube Cuff Pressure Using Standard Techniques. Prehospital Emergency Care. 11:3, 307-311

Ræder, M. G. (2006)  Grunnbok i kirurgisk patofysiologi og intensivmedisin

Sand, O. et al (2006).2. utg. Menneskekroppen: fysiologi og anatomi. Oslo: Gyldendal akademisk

Schalk, R, Meininger, D, Ruesseler, M, Obernd, D, Walcher, F, Zacharowski, K, Latasch, L, Byhahn, C (2011) Emergency airway management in trauma patients using laryngeal tube suction. Prehospital Emergency Care 2011; Volume 15, number 3: 347-350

Sollid, S JM, Heltne, J K, Søreide E, Lossius, H M (2008) Pre-hospital advanced airway management by anaesthesiologists: Is there still room for improvement? Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine  16:2 doi:10.1186/1757-7241-16-2

Sollid, Stephen JM, Lockey, David, Lossius, Hans M, and Prehospital advanced airway management expert group (2009) A consensus-based template for uniform reporting of data from pre-hospital advanced airway management. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2009, 17:58: 1-14

Sørensen, Jacob T, Terkelsen, Christian J, Nørgaard, Bjarne L, Trautner, Sven, Hansen, Troels M, Bøtker, Hans E, Lassen, Jens F, Andersen, Henning R (2010) Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocadial infarction. European Heart Journal (2011) 32, 430-436

Soroudi, A, Shipp, H E, Stepanski, B M, Ray, L U, Murrin, P A, Chan, T C, Davis, D P, Vilke, G M (2007) Adult Foreign Body Airway Obstruction in the Prehospital Setting. Prehospital Emergency Care 11:1, 25 – 29

Stannard, A, Ackroyd, C (2007) Sellick’s manoeuvre. Trauma 2007; 9: 127 – 129

Suffoletto, B P, Salcido, Salcido, D D, Menegazzi, J J (2008) Use of Prehospital-induced Hypothermia After Out-of-Hospital Cardiac Arrest: A Survey of the National Association of Emergency Medical Services Physicans. Prehospital Emergency Care 12:1, 52 – 56

Sunde et al (2010) Emergency intraosseous access in a helicopter emergency medical service: a retrospective study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2010, 18:52

Walz, J Matthias, Zayaruzny, Maksim, Heard, Stephen O (2007) Airway Management in Critical Illness. Chest 2007; 131:608-620

Wampler, David A, Collett, Lindsey, Manifold, Craig A, Velasquez, Christopher, McMullan, Jason T (2012) Cardiac arrest survival is rare without prehospital return og spontaneous circulation. Prehospital Emergency Care 2012; 16:451-455

Wang, H E, Katz, S (2007) Cognitive Control and Prehospital Endotracheal Intubation. Prehsopital Emergency Care 11:2, 234 – 239

Warden, C R, Morena, R, Daya, M (2008) Prospective Evaluation of Ondanestron for Undifferentiated Nausea and Vomiting in the Prehospital Setting, Prehospital Emergency Care, 12:1, 87 – 91

Warner, K J, Cushieri, J, Garland, B, Carlbom, D, Baker, D, Copass, M K, Jurkovich, G J, Bulger, E M (2008) The Utility of Early End-Tidal Capnography in Monitorering Ventilation Status After Severe Injury. J Trauma. 2009;66:26-31

Whyte, A J, Wang, H E (2007) Prehospital Airway Management Complicated by Reported Pseudocholinesterase Deficiency. Prehospital Emergency Care, 11:3, 343 – 345

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Supplerende opplysninger

Komplett litteraturliste desember 2014