SPECIAL CONDITIONS and PATIENT POPULATIONS Flashcards
Week 5
What is Home Medical Technology?
An external or internal mechanical device prescribed by a member of a regulated health profession for the purpose of treating a medical condition (ex. home dialysis machine)
What is Novel Medication?
A self/caregiver medication prescribed by a member of a regulated health profession that is required to treat patients with generally rare and unusually complex chronic medical conditions which are often end stage
What are 2 reasons why a patient is on Dialysis?
- Acute kidney failure (dialysis may be used for a short time, i.e. toxicity cases)
- Chronic or end-stage kidney failure dialysis is needed to replace the work of the kidneys (the kidneys do not get better and the pt. is on dialysis for the rest of their life)
What are the 2 different types of dialysis
- Hemodialysis
- Peritoneal dialysis
In general terms, what does Dialysis do?
It removes toxins from the blood
What are 5 potential causes of Renal failure?
- Diabetes (most common)
- Hypertension
- Autoimmune disease (Lupus, IgA nephropathy, etc..)
- Genetic diseases (passes from 1 or both parents), such as polycystic kidney disease
- Nephrotic syndrome
What is Hemodialysis?
It is a process that uses a man-made membrane (dialyzer) to remove wastes, such as urea, from the blood. It also aims to restore the proper balance of electrolytes in the blood and eliminate extra fluid from the body
What is a Fistula?
It is a surgical connection made between an artery and a vein that is created by a vascular specialist
Where is an AV Fistula typically located?
It is typically located in the arm but, it can be placed in the leg
Fill in the blank:
With an AV Fistula, blood flows from the artery directly into the vein, increasing blood _______ and amount of blood flow through the vein….causing the veins to enlarge which allows the veins to deliver the amount of blood flow necessary to provide adequate hemodialysis treatment
pressure
Why are AV Fistulas the preferred vascular access for long-term dialysis?
Because they last longer than any other dialysis access type, are less prone to infection, and can be relied upon for predictable performance
What is an AV Graft?
It is a form of vascular access which is created by inserting synthetic tube to connect a vein to an artery
Where is an AV Graft typically located? How long can they be ready for use?
They are typically located in either the right or upper left arm and can be ready for use in days to weeks
When is an AV Graft typically made?
When the veins are not suitable for an AV Fistula
What is a Central Venous Catheter?
A flexible synthetic (man-made) tube that is usually placed in the Vena Cava (it can also be placed in the groin/femoral vein)
When is a Central Venous Catheter used?
When a patient is waiting for a fistula or when a fistula is not possible
What is important to remember when you are dealing with a Central Venous Catheter?
That both clamps must be closed prior to disconnecting (close the patient side first and remember to clean the site)
What is Peritoneal Dialysis?
It is a process that uses the lining of your abdomen, or belly, (peritoneum) to filter the blood inside your body
How does Peritoneal Dialysis work?
- The peritoneal cavity is filled with a special dialysis fluid
- Excess water and wastes pass from the blood through the peritoneum into the dialysis fluid
- The fluid is then drained from your body and discarded
What are the 7 steps to Emergency Dialysis Disconnect?
- Utilize trained family or staff on scene if available (if not, wear PPE)
- Obtain disconnect kit (which will have instructions)
- Clamp the patient side
- Clamp the machine side
- Apply caps
- Cover site with dressing
- Don’t worry about the machine
What 8 drugs does dialysis remove?
- B: Barbiturates
- L: Lithium
- I: Isoniazid
- S: Salicylates
- T: Theophylline/Caffeine (Methylxanthines)
- M: Methanol, Metformin
- E: Ethylene glycol
8: D Depakote, dabigatran
What do Barbiturates do? Provide 1 example.
They produce a wide spectrum of central nervous system depression from mild sedation to coma, which is used for treating seizure disorders, neonatal withdrawal, insomnia, preoperative anxiety, the induction of coma to address increased ICP, and for inducing anesthesia.
EX. Butalbital
What does Lithium do?
It helps reduce feelings of mania (excited, high mood, distracted) and it also helps to treat bipolar episodes
What is Isoniazid?
It is an antibiotic that is used to treat Tuberculosis or to prevent its return
What are Salicylates? Provide 2 examples.
They are a type of drug found in many over-the counter and prescription medication that can help reduce a variety of biological issues such as fever and inflammation.
EX. Aspirin and Bismuth Subsalicylate
What are Methylxanthines? Provide 2 examples.
They are a purine-derived group of pharmacologic agents hat have clinal use because of their bronchodilatory and stimulatory effects.
EX. Caffeine and Theophylline
What does Metformin do?
It helps to control the amount of glucose in your blood and decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver
What is Methanol used for? Why is it toxic?
It is an organic compound that is used in the manufacture of formaldehyde and acetic acid, in chemical synthesis, in antifreeze, and as a solvent.
Because it can lead to severe health issues such as metabolic acidosis, CNS depression, and damage to the optic nerve
What is Ethylene Glycol? Why is it toxic?
It is an organic compound that is used mainly for two purposes: as a raw material in the manufacture of polyester fibers and for antifreeze formulations
Because it breaks down into toxic compounds within the body negatively affecting the CNS, then the heart, and then the kidneys
What is Depakote? What is it used for?
It is a medication that works to restore the balance of certain natural substances (neurotransmitters) in the brain.
It is used to treat seizure disorders, certain psychiatric conditions (manic phase of bipolar disorder), and to prevent migraine headaches
What is Dabigatran? What is it used for?
It is an anticoagulant (a chemical substance that prevents or reduces the coagulation of blood, prolonging clotting time)
It is used to treat and prevent blood clots and to prevent stroke in people with atrial fibrillation
What are 6 signs/symptoms of Acute Kidney Failure?
- Reduced urine output
- Swollen legs, ankles, and feet
- Weakness and fatigue
- High blood pressure
- Confusion
- Hyperkalemia
What is 1 common/possible cause of Acute Kidney Failure?
The patient missing their regularly scheduled dialysis appointment
What are 4 signs/symptoms of Chronic Kidney Failure?
- Abnormal blood and urine tests
- Swelling in the face, hands, and feet
- Headaches
- High blood pressure
What does Ventolin do in regards to treatment of Hyperkalmia?
It forces potassium back into the cell
List 8 reasons why a patient might get a Tracheostomy?
- Partial/complete airway obstruction
- Trauma
- Spinal cord injury
- Anaphylaxis
- Neuromuscular disease
- Extended period of unconsciousness
- Burns
- Cancer
What are 5 important questions to ask in you assessment of a tracheostomy patient?
- It is obstructed, partially or fully?
- Is a cuff present, and inflated?
- Why does the patient have a tracheostomy (underlying reason)
- When was it placed?
- Fenestrated or non-fenestrated
How would you ventilate a patient who’s tracheostomy does not have an inflated cuff?
You would cover their mouth and nose and then ventilate by connecting the BVM to the tracheostomy tube
How would you ventilate a patient who’s tracheostomy has an inflated cuff?
You would cover their tracheostomy opening and then ventilate over their mouth and nose (using a mask/BVM)
How would you ventilate a patient who has had a complete laryngectomy?
You would use a pediatric sized mask and ventilate over the tracheostomy opening
What are the 7 parts to a tracheostomy (with inflated cuff)?
- Outer cannula
- Inner cannula
- Pilot balloon
- Inner canula
- Obturator
- Plug
- Cuff
What is does it mean when an inner cannula is fenestrated? What is the benefit?
It means that it has a small hole in the cannula and it’s benefit is that it allows increased airflow to the upper airway allowing the patient to talk
What does it mean when an inner cannula is non-fenestrated? What is the disadvantage?
It means that it does not have a small hole, it is just a hollow tube and it’s disadvantage is that it offers little to no voicing
Fill in the blank:
The role of the upper respiratory tract is to filter, warm and humidify air, while the lower respiratory tract is primarily responsible for _____ ________
gas exchange
Fill in the blank:
When a person coughs there is a build up of pressure against the closed glottis/vocal cords to allow for buildup in pressure; this is ____ in a trach patient and therefore they are prone to obstruction from secretions
lost
True or false:
An intubation tube is placed for a variety of reasons, but they all aim to improve airway protection, ventilation or oxygenation
true
As per the ALS directive “Endotracheal and Tracheostomy Suctioning & Reinsertion”, what are the required indications?
Patient with endotracheal or tracheostomy tube AND airway obstruction or increased secretions
As per the ALS directive “Endotracheal and Tracheostomy Suctioning & Reinsertion”, what are the required conditions for suctioning?
Age: N/A
LOA: N/A
HR: N/A
RR: N/A
SBP: N/A
Other: N/A
As per the ALS directive “Endotracheal and Tracheostomy Suctioning & Reinsertion”, what are the required conditions for Emergency tracheostomy reinsertion?
Age: N/A
LOA: N/A
HR: N/A
RR: N/A
SBP: N/A
Other: Patient with an existing tracheostomy where the inner and/or outer cannula(s) have been removed from the airway AND respiratory distress AND inability to ventilate AND Paramedics are presented with a tracheostomy cannula for the identified patient
As per the ALS directive “Endotracheal and Tracheostomy Suctioning & Reinsertion”, what are the contraindications for suctioning?
N/A
As per the ALS directive “Endotracheal and Tracheostomy Suctioning and Reinsertion”, what are the contraindications for Emergency tracheostomy reinsertion?
Inability to landmark or visualize
As per the ALS directive “Endotracheal and Tracheostomy Suctioning & Reinsertion”, what is the maximum number of times you can attempt an Emergency tracheostomy reinsertion?
2 times
As per the ALS directive “Endotracheal and Tracheostomy Suctioning & Reinsertion”, what is the following for a patient < 1 year of age:
1. Dose
2. Max. single dose
3. Dosing interval
4. Max. # of doses
- Suction at 60-100 mmHg
- 10 seconds
- 1 minute
- N/A
As per the ALS directive “Endotracheal and Tracheostomy Suctioning & Reinsertion”, what is the following for a patient >or= 1 year to < 12 years of age:
1. Dose
2. Max. single dose
3. Dosing interval
4. Max. # of doses
- Suction at 100-120 mmHg
- 10 seconds
- 1 minute
- N/A
As per the ALS directive “Endotracheal and Tracheostomy Suctioning & Reinsertion”, what is the following for a patient >or= 12 years of age:
1. Dose
2. Max. single dose
3. Dosing interval
4. Max. # of doses
- Suction at 100-150 mmHg
- 10 seconds
- 1 minute
- N/A
As per the ALS directive “Endotracheal and Tracheostomy Suctioning & Reinsertion”, what are the clinical considerations for suctioning?
- Preoxygenate with 100% oxygen
- In an alert patient, whenever possible, have patient cough to clear airway prior to suctioning
As per the ALS directive “Endotracheal and Tracheostomy Suctioning & Reinsertion”, what are the clinical considerations for Emergency tracheostomy reinsertion?
- A reinsertion attempt is defined as the insertion of the cannula into the tracheostomy
- A new replacement inner or outer cannula is preferred over cleaning and reusing an existing one
- Utilize a family member or caregiver who is available and knowledgeable to replace the tracheostomy cannula
What can exceeding suction pressure or attempts cause?
Mucosal trauma and edema
What is a Left Ventricular Assist Device (LVAD)?
It is a temporary or permanent implantable pump that assist ventricles with patients that have advanced heart failure
True or false:
LVADs can have a pulsatile pump or a non-pulsatile pump?
true
Regarding LVADs, is the following true or false?:
With a pulsatile pump the patient will have a pulse similar to a human heart
true
Should you start CPR on a patient who has an LVAD?
No, chest compressions are not recommended
What is an Adrenal Crisis?
Addison’s Disease, also called adrenal insufficiency is an uncommon illness that occurs when the body doesn’t make enough of certain hormones
Fill in the blank:
In Addison’s Disease, the adrenal glands make too little cortisol and, often, too little, __________.
aldosterone
True or false:
Addison’s Disease can only affect adults and is not often life-threatening?
False; Addison’s Disease can affect anyone and can be life-threatening
What are 10 Symptoms of Adrenal Crisis?
- Hypotension
- Hypoglycemia
- Hair loss
- Back pain
- Fatigue
- Confusion & psychosis/ changes in behavior
- Fever
- Loss of consciousness
- Vomiting
- Joint pain
What does an Addisonian crisis result from?
Stress on the body, such as injury, infection or illness
True or false:
Adrenal glands make two or three times the usual amount of cortisol in response to physical stress?
true
What is cortisol
A stress hormone
Fill in the blank:
Not being able to increase the amount of cortisol made as a result of stress can lead to an _________ ______
Addisonian crisis
Fill in the blank:
Hydrocortisone is a hormone replacement for ______
cortisol
As per the ALS directive “Suspected Adrenal Crisis”, what are the required indications?
A patient with primary adrenal failure who is experiencing clinical signs of adrenal crisis
True or false:
Hydrocortisone is not carried by Paramedics but if a patient has it already then a Paramedic can administer it
true
As per the ALS directive “Suspected Adrenal Crisis”, what are the required conditions for hydrocortisone administration?
Age: N/A
LOA: N/A
HR: N/A
RR: N/A
SBP: N/A
Other: Paramedics are presented with a vial of hydrocortisone for the identified patient AND age-related hypoglycemia OR GI symptoms (vomiting. diarrhea, abdominal pain) OR syncope OR temperature >or= 38C or suspected/hx. of fever OR altered LOA OR age-related tachycardia OR age-related hypotension
As per the ALS directive “Suspected Adrenal Crisis”, what are the contraindications for hydrocortisone administration?
Allergy or sensitivity to hydrocortisone
As per the ALS directive “Suspected Adrenal Crisis”, what is the following for hydrocortisone administration?:
1. Route
2. Dose
3. Max. single dose
4. Dosing interval
5. Max. # of doses
- IM/IV
- 2 mg/kg
- 100 mg
- N/A
- 1
As per the ALS directive “Suspected Adrenal Crisis”, what are the clinical considerations?
IV administration of hydrocortisone applies only to PCPs authorized for PCP Autonomous IV
