急救員培訓課程

美國的急救員培訓課程

1精選課件前言上世紀六十年代美國開始培養(yǎng)專業(yè)急救人員現(xiàn)今,美國大多數(shù)州的急救員主要從消防員（firefighter）中選拔和培養(yǎng)，分為初級急救員（EMT）和高級急救員（Paramedic）兩個層次2精選課件前言洛杉磯急救員培訓中心（PTI）成立于1969年,經(jīng)過多年的教學實踐，已經(jīng)形成完善的教學體系每期培訓需7個月，包括課程學習和現(xiàn)場實踐培訓內(nèi)容包括基礎(chǔ)知識、操作技能和該領(lǐng)域的最新進展每周有2-3次的考核和講評，根據(jù)成績進行篩選，最后的淘汰率超過1/3經(jīng)過培訓的高級急救員已經(jīng)具備能應對絕大多數(shù)現(xiàn)場情況的急救知識和技能3精選課件院前急救人員培訓重點內(nèi)容4精選課件1、基礎(chǔ)知識解剖學和生理學：循環(huán)系統(tǒng)、呼吸系統(tǒng)和神經(jīng)系統(tǒng)藥物學：藥物的性質(zhì)、分類和作用，藥代動力學和藥效學，胃腸道給藥（口服、胃管、舌下黏膜、直腸），非胃腸道給藥（經(jīng)靜脈、骨髓、氣管導管、肌肉和皮下），急救藥物的應用5精選課件2、臨床知識診斷學：生命體征（vitalsigns）、病人評估和記錄（patientassessmentanddocumentation），心電圖學各系統(tǒng)急癥：心血管急癥和復蘇藥物，休克，呼吸急癥，神經(jīng)系統(tǒng)急癥，腹部非創(chuàng)傷急癥，腎臟和泌尿系統(tǒng)急癥，內(nèi)分泌急癥，血液急癥，傳染性急癥創(chuàng)傷性急癥：損傷機制，現(xiàn)場分檢，頭面部、脊柱、胸部、腹部、肌肉和軟組織創(chuàng)傷，燒傷6精選課件2、臨床知識婦產(chǎn)科急癥：緊急分娩，出血兒童急癥：病情評估，各系統(tǒng)急癥，兒童創(chuàng)傷特點，兒童氣道管理，兒童虐待其它急癥：急性中毒和藥物過量，環(huán)境因素所致急癥，精神行為異常所致急癥核、生物和化學武器所致災難7精選課件3、社會學知識與院前急救有關(guān)的法律法規(guī)急救專業(yè)特點和職業(yè)道德老年人的相關(guān)問題院外死亡犯罪現(xiàn)場的保護急救人員壓力疏導8精選課件4、技能操作病人評估基本生命支持（BLS）：成人CPR，兒童CPR，呼吸道異物排除高級氣道管理：氣囊-活瓣-面罩輔助呼吸囊（BVM），氣管內(nèi)導管，食道氣管雙腔導管。電治療：電除顫，同步電復律非胃腸道給藥方法：經(jīng)靜脈、骨髓、氣管導管、肌肉、皮下9精選課件4、技能操作胸腔針刺排氣氣管環(huán)穿刺夾板固定脊柱固定緊急分娩兒童復蘇帶抗休克褲現(xiàn)場急救藥物10精選課件4、技能操作模擬急救現(xiàn)場臨床見習參觀大型教學醫(yī)院急診科參觀病理解剖所11精選課件理論課程內(nèi)容

ContentsofParamedicTraining

12精選課件MedicalTerminology醫(yī)學名詞PrefixesSuffixesRootwordAbbreviationsAcronyms13精選課件

SurfaceAnatomy大體解剖

AnatomicaldivisionsThetenhumansystems:integumentary,skeletal,muscular,cardiovascular,respiratory,digestive,renal,endocrine,nervous,reproductive14精選課件AppliedPhysiology應用生理CellMetabolism:acid-basebalance,fluidsandelectrolytesinflammation15精選課件CirculatorySystem循環(huán)系統(tǒng)WholebloodArteries,capillaries,veinsPressure,perfusionCirculatoryabnormalitis16精選課件Normalheart正常心臟StructureMechanismBloodflowthroughtheheartHeartvalvesCoronarycirculationConductionsystemElectricaleventCardiacoutput17精選課件RespiratorySystem呼吸系統(tǒng)UpperairwayandlowerairwayLungsGasexchangeprocessesMechanicsofbreathingRespiratorydistressRespiratoryassessmentAbnormalbreathsounds18精選課件TheNervousSystem神經(jīng)系統(tǒng)NeuronCerebralspinalfluidBrain:cerebrum,hypothalamus,cerebellum,brainstemSpinalcordPeripheralnervoussystemSomaticnervoussystem19精選課件NeurologicalAssessment神經(jīng)狀態(tài)評估GCSCerebraldysfunctionInter-cranialpressure(ICP)Levelofconsciousness(LOC)AbnormalrespiratorypatternsSpinalcordinjury20精選課件VitalSigns生命體征TemperaturePulseVentilationBloodpressureSkinassessment21精選課件EMSReportFormTraining急救記錄報告的書寫Documentation文書ProfessionalismandEthics職業(yè)道德和倫理22精選課件PatientAssessment患者評估Scenesize-upInitialassessmentFocusedhistoryandphysicalOngoingassessmentDetailedphysicalexamRadioreport23精選課件AsepticTechniques控制感染技術(shù)MedicalasepsisSurgicalasepsisSterileconsciencePre-existingvascularassessdevice(PVAD)24精選課件IntravenousTherapy侵入性治療技術(shù)IntravenousequipmentVenousaccesssitesIVcannulationtechniqueEquivalentsandConversion計量和換算25精選課件BasicPharmacology藥物學基礎(chǔ)Drugnames,sources,classificationDruglawsandregulationsSchedulesofdrugsFormsofdrugsParamedicresponsibilitieswithmedicationadministrationRoutesofdrugsadministration:enteralroutes,parenteralroutes26精選課件BasicPharmacology藥物學基礎(chǔ)Phasesofdrugactivity:pharmacokinetics,pharmacodynamicsActionsofdrugsResponsestodrugadministrationDrugresponserelationshipDrugprofileLAcountyapprovedmedications27精選課件MedicationAdministration給藥途徑Bodysubstanceisolation(BSI)AseptictechniquewithMASixrightsofMADICCEpriortoMA28精選課件MedicationAdministration給藥途徑Enteralroutes:oraldrugadministration,gastrictubeadministration,sublingual(SL)administration,buccal(TM)administration,rectaladministrationParenteralroutes:intravenous(IV)administration,intraosseous(IO)administration,endotracheal(ET)administration,intramuscular(IM)administration,subcutaneous(SQ)administration29精選課件IntroductiontoIVTherapy靜脈療法Types,packagingofIVfluidsTypesofIVtubingSettingupanIVlineCathetersVenousaccesssitesIVcannulationtechnique30精選課件IntroductiontoIVTherapy靜脈療法PeripheralIVaccessinanexternaljugularveinComplicationsofIVtherapyIVbolustechniqueIVpiggyback(IVPB)Drawingupmedications31精選課件AdvancedAirwayManagement高級氣道管理ReviewofupperairwayAnatomyreviewBasicairwayreviewOxygendeliverySuctioningOPairwaysNPairwaysBag-valve-mask32精選課件AdvancedAirwayManagement高級氣道管理Sellick’smaneuverDifficultairwayevaluationIntubationMulti-lumenairway(combi-tube)sMagillforcepsTracheostomy/LaryngectomyETmedicationadministrationNeedlecricothyroidology33精選課件IntroductiontoEKG心電圖基礎(chǔ)MusclephysiologyConductionsystemMonitorandleadsMorphology34精選課件SinusMechanisms竇性心律NormalsinusrhythmSinustachycardiaSinusbradycardiaSinusarrhythmiaSinusarrest35精選課件AtrialMechanisms房性心律Prematureatrialcontraction(PAC)Supraventriculartachycardia(SVT)ParoxysmalSupraventriculartachycardia(PSVT)Wolf-Parkinson-Whitesyndrome(WPW)AtrialflutterAtrialfibrillation36精選課件JunctionalMechanisms交界性心律Prematurejunctionalconreaction(PJC)JunctionalescapebeatsorcontractionsSpecificjunctionalrhythms:escapejunctionalrhythm,acceleratedjunctionalrhythm,junctionaltachycardia37精選課件VentricularMechanisms室性心律Prematureventricularcontraction(PVC)VentricularescapebeatsorcomplexesSpecificventricularrhythms:ventricularbigeminy,ventricularescaperhythm,acceleratedventricularrhythm,venrtriculartachycardiaTorsadesdepoint38精選課件VentricularMechanisms室性心律VentricularconductiondisturbanceVentricularfibrillationAgonalrhythmAsystole39精選課件HeartBlocks心臟傳導阻滯1stdegreeheartblock2nddegreeheartblock:type1,type23rddegreeheartblock40精選課件ArtificialPacemakers/InternalDefibrillators人工起搏器/體內(nèi)除顫Typesofpacemakers:trancutaneous,external,internalAutomaticinternalcardioverter/defibrillator(AICD)41精選課件Cardioversion/Defibrillation電復律/電除顫

Defibrillation:concepts,procedureSynchronizedcardioversion:indications,procedure42精選課件Cardiovascularemergencies心血管急癥Coronaryarterydisease(CAD):anginapectoris,myocardialinfarctionCardiogenicshockAorticaneurysmAcutearterialocclusionHypertensionandhypertensiveemergencies43精選課件CardiacArrestDrugs心臟復蘇藥物EpinephrineAtropineLidocaineCalciumchlorideSodiumbicarbonate44精選課件CardiacArrestDrugs心臟復蘇藥物Pulselesselectricalactivity(PEA)Pulselessventriculartachycardia/ventricularfibrillationPostresuscitationgoalsCongestiveheartfailure:rightsided,leftsided45精選課件Shock休克MechanismsStages:compensated,decompensated,irreversibleHypovolemicCardiogenicObstructiveDistributive:septic,neurogenic/spinal,anaphylacticPneumaticanti-shockgarments(MASTsuit)46精選課件RespiratoryEmergencies呼吸急癥

RespiratorystructureandfunctionreviewUpperairwayobstruction/lowerairwayobstructionEpiglotitisAsthmaChronicobstructivepulmonarydisease(COPD)PneumoniaPleurisy47精選課件RespiratoryEmergencies呼吸急癥AllergicreactionPulmonaryembolismHyperventilationsyndromeSpontaneouspneumothoraxAcuterespiratorydistresssyndrome(ARDS)LaryngectomyTracheotomy48精選課件NeurologicalEmergencies神經(jīng)急癥Glasgowcomascale(GCS)Alteredlevelofconsciousness(ALOC)SyncopeSeizureTransientischemicattack(TIA)Cerebralvascularaccident(CVA)Symptomatichypertension/hypertensivecrisisAcutealcoholwithdrawal49精選課件AbdominalEmergencies腹部急癥GIsystemoverviewTypesofabdominalpainInitialassessmentFocusedassessmentGIbleedingAcutegastroenteritis50精選課件AbdominalEmergencies腹部急癥ColitisDiverticulitisAppendicitisPepticulcerdiseaseBowelobstructionCrohn’sdisease51精選課件AbdominalEmergencies腹部急癥PancreatitisEsophagealvaricesHemorrhoidsCholecystitis/cholelithiasisCirrhosisAcutehepatitisDissectingaorticaneurysmKinneystonesUrinarytractinfectionPelvicinflammatorydiseaseEctopicpregnancy52精選課件RenalandUrologicalEmergencies腎臟和泌尿系統(tǒng)急癥UrologicalandkidneyanatomyPhysicalassessmentAcuterenalfailureChronicrenalfailureDialysis:hemodialysisandperitonealdialysisRenalcalculi(kidneystones)53精選課件RenalandUrologicalEmergencies腎臟和泌尿系統(tǒng)急癥Urinarytractinfection(UTI)TesticulartorsionPriaprismParaphimosisFourniergangreneUrinaryretention54精選課件EndocrineEmergencies內(nèi)分泌系統(tǒng)急癥

Diabetesmellitus(type1andtype2)Glucose,carbohydrate,fatandproteinmetabolismDiabeticketoacidosis(DKA)Hyperosmolarhyperglycemicnonketoticsyndrome/coma(HHNK)Hypoglycemia55精選課件EndocrineEmergencies內(nèi)分泌系統(tǒng)急癥Disorderofthethyroidgland:Graves’disease,thyrotoxiccrisisandhypothyroidismDisordersoftheadrenalglands:hyperadrenalism(Cushing’ssyndrome),adrenalinsufficiency(Addison’sdisease)56精選課件HematologyEmergencies血液系統(tǒng)急癥

BloodtypesAnemiaSicklecelldiseasePolycythemiaLeukopenia/neutropeniaLeukocytosisLeukemia57精選課件HematologyEmergencies血液系統(tǒng)急癥LymphomaThrombocytopeniaThrombocytosisHemophiliaVonWillebrand’sdiseaseDisseminatedintravascularcoagulation(DIC)Multiplemyeloma58精選課件CommunicableDisease傳染病ChainoftransmissionTetanusLymediseaseRabiesImmunesystemHumanimmunodeficiencyvirus(HIV)/AIDS59精選課件CommunicableDisease傳染病HepatitisTuberculosisMeningitisChildhooddisease:chickenpox,mumps,rubeola,rubellaPrevention60精選課件SubstanceAbuse/Overdose

中毒/藥物過量CNSdepressants:alcoholCNSstimulantsHallucinogensDesignerdrugsPharmaceuticalagentsTricyclicantidepressants61精選課件SubstanceAbuse/Overdose

中毒/藥物過量Industrial/agriculturalchemicalcaustics:strongacidsorbases,hydrocarbons,metals,non-potablealcoholandglycols,organophosphates,cyanidePlantpoisoningPhenothiazinereactionFoodpoisoningBiologicalagents62精選課件MechanismsofInjury創(chuàng)傷機制BluntPenetratingLoadandGoCriteria“搬-運”原則TraumaArrest/VolumeResuscitation創(chuàng)傷性心臟驟停/容量復蘇63精選課件Facial-HeadandSpinalTrauma

頭-面部和脊柱創(chuàng)傷Ear:acuteotitismedia,laceration/avulsion,Perforatedeardrum,BasilarskullfractureNose:epistaxis,nosalfractureFaceandneck:facialfracture,impaledobjects,severefacialinjury,tracheal/laryngealfractureSkull:scalpinjuries,skullfracture64精選課件Facial-HeadandSpinalTrauma

頭-面部和脊柱創(chuàng)傷Meningealandvesselinjury:hematoma,hemorrhage,concussion,cerebralcontusion,anoxicbraindemageSpinalinjurySpinalimmobillzation65精選課件OcularEmergencies眼部急癥ConjunctivitisCataractsGlaucomaDetachedretinaCentralretinalarteryocclusionAnisicoria(unequalpupils)SubconjunctivalhemmorhageOcularforeignbodyChemicalexposuresLacerations66精選課件ChestandAbdominalTrauma

胸部和腹部創(chuàng)傷

LeadingmechanismsofchestandabdominaltraumaTracheobronchialrupture/laceration/fractureOpenpneumothoraxTensionHemothoraxFlailchestCardiactamponadeThoracicaorticdisruptionSimplepneumothorax67精選課件ChestandAbdominalTrauma

胸部和腹部創(chuàng)傷

MyocardialcontusionDiaphragmatictear/herniaEsophagealinjuriesPulmonarycontusionOrgansofabdomen:solid,hollowEviscerationMustsuit68精選課件MusculoskeletalInjuries肌肉骨骼損傷

AssessmentNeurovascularcompromisePulse-motor-sensation(PMS)Muscles:tendons,ligaments,jiontsBones:fracture,strains,sprainsDislocationsClassificationsoffractures69精選課件MusculoskeletalInjuries肌肉骨骼損傷AmputationsSofttissueinjuriesSplintingFractures:femur,pelvic,hip,tibiaandfibula,clavicle,ribDislocations:hip,kneeInjuries:upperextremity,shoulder,elbow,footandankle70精選課件CrushingTraumaandItsAftermath擠壓創(chuàng)傷和處理Burns燒傷Classification:1,2,3,4degreeRuleofninesThermalElectricalChemicalRadiationFrictionInhalationinburies:COpoisoningBurnshock71精選課件

MultipleCasualtyIncident

突發(fā)災難事件應對

disasterincidentcommandsystemclassificationsystems(initialtriage):SimpleTriageandRapidTreatment,S.T.A.R.Tplan72精選課件Gynecological/OB/TraumaEmergencies婦產(chǎn)科創(chuàng)傷急癥Pelvicinflammatorydisease(PID)OvariancystCystitisReviewofobstetricalanatomyandphysiologyTraumainpregnancyVaginalbleeding73精選課件Gynecological/OB/TraumaEmergencies

婦產(chǎn)科創(chuàng)傷急癥EctopicpregnancyThirdtrimesterbleeding:placentaprevia,abruptioplacenta,uterinerupturePre-termlaborPostpartumhemorrhage74精選課件EmergencyChildbirth急產(chǎn)AnatomyandphysiologyCharacteristicsoflaborStagesoflaborProgressionoflaborDeliveryprocessTheAPGARscore75精選課件EmergencyChildbirth急產(chǎn)NeonatalresuscitationAdditionalcareformotherComplicationsofpregnancyComplicationsoflaboranddeliveryComplicateddeliveries76精選課件Pediatric:Newborn/Toddler/SIDS兒童：新生兒/幼兒/嬰兒猝死綜合征

NewbornInfantsToddler77精選課件Pediatric:Newborn/Toddler/SIDS兒童：新生兒/幼兒/嬰兒猝死綜合征

Neurologicalemergencies:seizures,meningitis,acutelifethreateningepisode(ALTE)Croup,bronchiolitis,acutegastroenteritis(AGE),vomiting/diarrhea,motorvehicletrauma,drowningChildabuse/neglect:indicationsSuddeninfantdeathsyndrome(SIDS)78精選課件ThePediatricAssessmentTriangle(PAT)兒童評估分類PediatricCardiovascularEmergencies兒童心血管急癥PediatricRespiratoryEmergencies兒童呼吸急癥NewbornAssessment新生兒評估79精選課件PediatricReview(part1)兒童急救復習1newborn,infants,toddler,preschooler,school-age,adolescent,pediatricassessment:appearance,breathing,circulation,vitalsigns80精選課件PediatricReview(part2)兒童急救復習2

PediatricmedicalemergenciesNeurological:seizures,meningitisRespiratory:croup,epiglottitis,asthma,bronchiolitisCardiovascular:shock(hypovolemic,distributive,cardiogenital),congenitalheartdisease,dysrhythmia,cardiacarrestdrugs81精選課件PediatricReview(part2)兒童急救復習2Gastrointestinal/genitourinary:hypoglycemia,gastroenteritis,appendicitis,vomiting/diarrhea,diabetesmellitusIIntegumentary:burnsGenitourinary:urinarytractinfection,testiculartorsionSkeletal:strains/sprains,fructures82精選課件PediatricReview(part3)兒童急救復習3

Pediatrictrauma:motorvehicletrauma,drowning,burns,gswChildabuse:physical,emotional,sexual,neglect83精選課件PediatricAirwayManagement

兒童氣道管理DifferencesbetweenpediatricandadultairwaysUpperairwayobstructionLowerairwayobstructionOropharyngealairway(OP)Nasopharyngealairway(NP)Bag-valve-maskventilation84精選課件PediatricAirwayManagement

兒童氣道管理Foreignbodyobstruction-infant/childPediatricendotrachealintubation/extubation/ETmedfluidadministrationComplicationsofBVMventilationComplicationsofETintubationCO2detectors85精選課件EnvironmentalEmergencies

環(huán)境因素所致急癥Heatemergencies:cramps,exhaustion,strokeColdemergencies:hypothermia,frostbiteWateremergencies:drowning,neardrowningDivingemergencies:airembolism,decompressionsicknessAltitudesickness:acutemountainsickness,highaltitudepulmonaryedema,highaltitudecerebraledema86精選課件EnvironmentalEmergencies

環(huán)境因素所致急癥InsectstingsSnakebitesSpiderbitesHazardousaquaticlife87精選課件BehavioralEmergencies行為所致急癥

NormalandabnormalbehaviorBiological/organiccausesCognitivedisorders:delirium,dementia,Alzheimer’sSchizophreniaAnxietydisordersPanicdisordersPhobiasPosttraumaticstresssyndrome88精選課件BehavioralEmergencies行為所致急癥DepressionBipolardisordersPersonalitydisordersImpulsecontroldisordersManagementofpatientsRestraintsStressAnxietySuicide89精選課件SpecialNeedsPatients/ChronicCareChemotherapeuticAgents特殊/老年人急癥Hearingimpairments:conductive,sensorineuralVisualimpairmentsSpeechimpairments:language,articulation,voiceproduction,fluencyObesityParalysis90精選課件SpecialNeedsPatients/ChronicCareChemotherapeuticAgents特殊/老年人急癥DevelopmentallydisabledDownsyndromeFetalalcoholsyndromeOstroarthritisCerebralpalsyCysticfibrosisMultiplesclerosisMusculardystrophy91精選課件SpecialNeedsPatients/ChronicCareChemotherapeuticAgents特殊/老年人急癥PoliomyelitisSpinabifidaMyasthemiagravisCulturallydiversepatientsCancerChemotherapyAcu