Special Challenges Emergencies Flashcards
Physical Abuse
Defined as intentional act such as striking, hitting, or biting a child that results in injury
Neglect
Four times more common than physical abuse
Sexual Abuse
Inappropriate dressing, touching to disabled patients
Emotional Abuse
Children, dependent elderly, and other vulnerable people
Causes substantial emotional response in behavior in children
Recognizing Neglect or Abuse
Child who does not become agitated
Who does not look for parent reassurance
May cry excessively or not at all
-80% of head injuries in patients younger than 2 years is a result of abuse
Mongolian Spots
Lesions that resemble bruises typically on buttocks or back that present at birth
Benign Injuries
Coining and Cupping
- rubbing hot coins
- warm cups on skin pull out illness
Management of Abuse/Neglect
First priority: self safety
Second priority: provide optimal clinical care to patient
Don’t make hasty assumptions
Document situation!
Mandatory Reporters
EMS is mandatory reporters of child abuse and neglect
APS
Adult Protective Services
-for neglected or abused children
Terminal Illness
Disease that is expected to cause death within 6 months
Curative Care
Continuous aggressive medical care that attempts to prolong life
Palliative Care
“Comfort Care”
Focus on improving the quality of the time that the patient has left
Hospice
Program that provides social and emotional support
May receive at home, hospital and long term care facilities
Surrogate-Decision Maker
Legally authorized to make health care decisions for that patient when patient is not able to to make them for them self
Communicable Diseases
Medical conditions that can be passed from one person to another by variety of modes
-gloves and eye wear mandatory
Tracheostomy Tubes
Long term replacement for ET tubes
- passes below the thyroid cartilage into the trachea
- needs humidified and warmed air
- Obturator: rounded tip that extends out the bottom end of the trachea
- follow DOPE acronym for trouble shooting trach tubes
- have patient that deep breath or preoxygenate before entering suction into tube
Fenestrated
Teach tube that has holes present in outer and inner canulas
False Lumen
If suction catheter meets resistance outside of cannula it may be displaced
Stoma
Incision from which a trach tube has been insrted
Diaphragm/Phrenic Nerve stimulators
New technology that stimulates the process of breathing for a patient without an external device
Asynchrony
May occur when breathing is stimulated and is being ventilated by EMS
VAD’s
Ventricular Assist Device
- receive devices while awaiting a heart transplant
- connected to either both or right or left ventricles
Apnea Monitors
Infants with high risk of SIDS have one
-usually have ECG tracings
Long Term Vascular Access Device
May have central lines in place
- many are maintained with chemical heparin
- obtain med control before using one
- remove 10ml of blood before flushing to remove heparin
Insulin pump
Titration insluin into the body for diabetics
Tube Feeding
Placed into small intestine or into stomach
Colostomy
Directs large intestine out through an opening in the wall called a stoma
-stool and intestinal liquid is drained from the intestines
Urostomy
Part of urinary system is diverted through an opening in the anterior abdominal wall, called a stoma
Urinary Catheterization
Not able to void urine on their own
- mask, goggles and gloves
- keep catheter very sterile!
- coat catheter with gel substance
- hold penis at ninety degree angle
- when urine present, insert 1cm more or until it reaches Y of tubing
- Inflate ballon and gently pull back until feeling resistance
Dialysis
Replacement for failed or failing kidneys
Hemodialysis: removes blood from patient through fistula which is connected between artery and vein. Blood exits, cleaned, and returned to body
Peritoneal Dilaysis: abdominal dialysis and can be performed in the patients home
IABP
Intraday-Aortic Balloon Pump
Decrease the cardiac workload and perfusion in patients with cardiogenic Shock, structural abnormalities in heart, MI or following cardiac surgery
-cylindrical tube inserted through femoral artery and placed in aorta
-During diastole the balloon inflates, pushing blood forward into systemic circulation.
-During systole the balloon deflates, creating brief vacuum and decreasing cardiac afterload
-Improves circulation, decreases oxygen demand
Developmental Disability
Severe chronic conditions due to mental or physical impairments
Developmental Delay
Infant or child’s failure to reach a particular development milestone by the expected time
Down Syndrome
Inherited genetic disorder that is responsible for the delay, cognitive impairment, and unusual features.
- flattened face and nose
- also known as “trisomy 21”
- missing a pair or chromosomes compared to normal 23 chromosomes
- shorter life expectancy
- may function relatively independently
Mental Retardation
Intellectual disability and cognitive disorder that appears during childhood and lacks adaptive behavior
-IQ below 70 is classified
Autism
Developmental delay that is still being diagnosed
- Be mindful of actions
- Excessive stimuli can cause aggressive behavior
Conversion Disorder
“Hysteria”
Blindness, paralysis, and impaired speech can occur as a physical manifestation
Hearing Impairment
Acoustic Neuroma: tumor of ear
Conductive Hearing Loss: inability of sound to travel from outer to inner ear
Sensorineural Hearing Loss: problems with uptake of sound through tiny hairs within the ear and conduction of nerve impulses
CAPD: auditory deficit that is difficult interpreting speech, when other background noises are present
Auditory Neuropathy: normal function of ear, but can not pick up Nerve impulses
Visual Impairment
Retinopathy: diseases of the retina and the eye that do not involve inflammation
- high levels of oxygen to infants can cause retinopathy
- Amblyopia: partial or complete vision loss of one eye
- Hyperopia: frsightedness
- Myopia: Nearsightedness
Speech Impairment
Phonological Process Disorders: impact a persons ability to produce sounds that combine into spoken words
Semantic-Pragmatic Disorder: delayed language developmental milestones, with person using irrelevany phrases out of context
Dysarthria
Failure of neurotransmission between nervous system and muscles of the face and throat that causes impaired speech
Apraxia
Can not apply object to use
Spastic Parylsis
When muscles if affected areas of the body become flaccid or fail to move because of continued spasm
Autonomic Dysreflexia
When the quad or parapalegic can not use the bathroom, constipated, pain, triggers a large dump of catecholamines and causes massive vasoconstriction above level of injury and pressure can be dangerously high
Arthritis
Inflammation of joints between bones that can cause pain, swelling, redness, stiffness and discomfort
Osteoarthritis
Caused by cartilage loss or abnormal bone growth,usually in response to trauma or excess wear and tear
Rheumatoid Arthritis
Systemic inflammatory disease that affects joints and other body systems
Consider pain medications
Cancer
Excessive growth in the body and division of cells within the body
Cerebral Palsy
Neurological disorder that results from injury to brain tissue during brain development
- Produces altered skeletal muscle function or contraction
- Common to affect only one region of the body
- sever: seizures, inability to swallow, tremors, loss of bladder control, joint contractions, impaired respiratory function
Spastic Tetraplegia
When CP affects all four limbs
Cystic Fibrosis
Increased production of mucus in the lungs and digestive systems
- Can lose a lot of salt
- Nausea, constipation, diarrhea, pancreatitis, anorexia, and distended abdomen
- Take antibiotics
MS
Multiple Sclerosis
Degenerative disorder of the myelin sheath surrounding the neurons of the brain
Muscular Dystrophy
Slow, progressive degeneration of muscle fibers
- Careful positioning
- Supportive Treatment
- Assisted Ventilation
DMD
Duchenne Muscular Dystrophy
Enlarged heart muscle
Myasthenia Crisis
Respiratory failure due to respiratory muscle fatigue
- may occur if muscles damaged by infection
- infection, stress, side effects of medications can trigger a crisis
- Contraindicated for ZOFRAN because of issues with Long QT syndrome
Myasthenia Gravis
Autoimmune disorder that suddenly or gradual impacts neuromuscular transmission, causing muscles to weaken and tire easily
Poliomyelitis
Viral infection with significant morbidity
- Humans only host to carry polio
- Headache, sore throat, fever, malaise, and vomiting
- Report back pain, diarrhea, leg pain, continued fever, and muscle discomfort
Postpolio Syndrome
Persons who survive an initial attack from polio virus
- Muscle weakness, muscle atrophy
- Treatment remains supportive
Systemic Lupus Erythematosus
Autoimmune disorder characterized by widespread inflammation of many body tissues
Antibodies in body attack normal body cells such as kidneys, muscles, joints, digestive tract, skin
-Swelling and discomfort, chest pain, fever, sensitivity to light, swollen lymph nodes, mouth sores.
Traumatic Brain Injury
Deformity of brain from injury that can cause short term and long term impairments.
-Seizures, emotional, behavioral, sensory complications can be present
