Special Populations Flashcards
disability
conditions interfering with the ability to engage in activities of daily living
hearing loss
can come from trauma/medical or congenital birth defect
advanced directive that EMS uses
DNR
what can we do help you - what works well - how do you normally move the pt
.
ventilate with BVM
.
congential disease
from birth
Acquired
deafness could be in both categories
CPAP
Continuous Positive Pressure Devices
trach tube 15mm adapter BVM fits on it
….
AICD - Automatic Internal Cardiac Defibrillator
if it is firing it is an ALS call
don’t take blood pressure on the arm with a fistula
..
PICC line
peripherally inserted central catheter - central IV catheter
Disability
• Condition interfering with the ability to engage in activities of daily living
• Developmental disability
– Cerebral palsy, Down syndrome
• Result of traumatic injury or medical condition
– Multiple sclerosis, Parkinson’s, stroke, traumatic brain injury, spinal cord injury
Terminal Illness
• End stage cancer, heart failure, kidney failure, progressive fatal diseases
(Huntington’s, Lou Gehrig’s)
• May depend on technology to sustain life or relieve pain
• Advance directives
• Special emotional needs
Obesity
- Increases risk of multiple diseases
- Special measures to care for obese patient
- Allow patient to assume comfortable position for breathing
- Have enough assistance when lifting or moving patient
Homelessness and Poverty
• Serious health problems related to homelessness and poverty – Mental health problems – Malnutrition – Substance abuse problems – HIV/AIDS – Tuberculosis – Pneumonia
Autism
• Affects 1 in 91 children
• Affects ability to communicate
• May need to modify assessment
techniques and treatment protocols
ABCS of Dealing with Autistic Patients
- Awareness
- Basic
- Calm
- Safe
Autism Awareness
- EMT must adapt approach and strategies to patient
- Disruption of routine not well tolerated by patient
- Communication can be challenging
- May have escalation or meltdown—involuntary tantrum-like behavior
Autism Interactions Basics
- Instructions—simple, clear precise
- Questions—short, closed-ended
- Equipment—keep to minimum; do not overstimulate
- Treatment—defer interventions that are precautions rather than necessary
Autism Calm
- Calm creates calm
- Start with one-to-one contact
- Clear, controlled voice
- Empathy, compassion
- Take extra time—unless life-threatening emergency, follow patient’s timeline
Autism Safe
- Begin treatment where patient is found
- Remove things that may aggravate child
- Do toe-to-head survey, one step at a time
- Consider taking breaks during exam
- Let patient tell you when ready for next step
Advanced Devices: Knowledgable Caregivers / Pt
- Caregivers likely trained on device
- Ask: Has problem occurred before? What fixed it?
- Have you been taught how to fix this problem?
- Have you tried to fix this problem? What happened?
- How do you normally move patient?
Following Protocols
- Is the problem with the device life threatening?
- Do I have the knowledge to fix this problem?
- Do I have supplies needed to fix this problem?
- Is it within my protocols or within medical control authorization?
Types of Diseases
• Congenital
– Congenital heart disease, cleft palate, congenital deafness
• Acquired
– COPD, AIDS, traumatic spinal cord injury, deafness
Special Concerns
• Patient with a chronic disease may experience sudden worsening of disease
• Patient may also develop acute illness
– Acute illness may be more devastating because of coexisting chronic disease
Respiratory Devices
- Continuous positive airway pressure devices
- Tracheostomy tubes
- Home ventilators
EMT Assessment and Transport
- Problems not usually related to machine
- Patient may wish to bring machine to hospital
- Alert ER staff of use in radio report
Tracheostomy Tubes
- Surgical opening through neck into trachea in which breathing tube is placed
- BVM fits on end of tube
- Mucus build-up in tube
- Patient may or may not be able to speak
EMT Assessment and Transport
Tracheostomy Tubes
- Check tube
- If clogged, clear using whistle tip catheter
- Patient may buck during suction
- May need to ventilate with BVM
- During transport, elevate patient’s head to allow drainage
Home Ventilators EMT Assessment & Transport
- Make sure vent tube has no mucus build-up
- Assure that BVM is connected to oxygen
- If transporting ventilator, secure device
Cardiac Devices
- Implanted pacemaker
- Automatic implanted cardiac defibrillator (AICD)
- Left ventricular assist device (LVAD)
AICD
- Implanted in upper left chest or upper left abdominal quadrant
- Detects life-threatening cardiac rhythms
- Delivers shock to correct dysrhythmia
- Shock very painful to patient
- Cannot be felt by caregivers
EMT Assessment and Transport: ACID
- May want to request ALS
- Treat as high-risk cardiac patient
- High-concentration oxygen
- Frequent reassessment
- If cardiac arrest, use CPR and AED as indicated
LVAD EMT Assessment and Transport
- Battery failure: plug into AC source
- Pump failure: use hand or foot pump
- Battery should be secured so as not to pull tubing
Gastrourinary Devices
- Feeding tubes
- Urinary catheters
- Ostomy bags
Feeding Tubes EMT Assessment and Transport
- Secure tube to patient’s body with tape prior to transport
- Keep nutrients higher than tube
- Put protective cap in place to prevent leakage
Urinary Catheters EMT
Assessment and Transport
- During transport, keep catheter bag lower than patient (not on floor)
- Document any urine discoloration or odor
- Empty bag if one-third to one half full
- Document amount emptied
Ostomy Bags
- Connected to site of colostomy or ileostomy
- Not visible through clothing
- Common problems: infection at stoma site, blockage, dislodgement
Ostomy Bags EMT
Assessment and Transport
- Use care when transporting patient
* Object is to prevent breakage or dislodgement of bag
Dialysis
• Patient has renal failure • Dialysis replaces functions of kidney: waste removal and fluid removal • Two forms of dialysis – Hemodialysis – Peritoneal dialysis
Hemodialysis
- Performed by attaching patient to external machine (dialyzer)
- Usually at dialysis center
- Large needles and tubing remove and return blood
- Complications: bleeding from A-V fistula, infection
Peritoneal Dialysis
- Permanent catheter implanted through abdominal wall into peritoneal cavity
- Dialysis solution runs into abdominal cavity and is absorbed by intestines
- Complications: dislodging of catheter, infection (peritonitis)
Dialysis EMT
Assessment and Transport
- Don’t take blood pressure on any arm with shunt, fistula, or graft
- Rupture of shunt, fistula, or graft causes fast, significant blood loss
- Direct pressure to control bleeding
- Treat for shock
- Transport
Central IV Catheters
• Surgically inserted for long-term delivery of medications or fluids
– IV chemotherapy, parenteral nutrition
• Peripherally inserted central catheter (PICC)
• Central venous line
• Implanted port
• Complication: infection at site
Central IV Catheters EMT
Assessment and Transport
- Use of central IV usually restricted to hospital personnel
- Be aware of type of catheter
- Avoid tugging
- Avoid contamination
Physical Impairments
• Hearing, sight, speech, walking, standing
• Each limitation requires different
assessment/treatment approaches
• Physical impairment does not mean mental impairment
• Impairment may be partial or complete
Physical Impairments EMT
Assessment and Transport
- Provide necessary assistance
- Assess impairment—baseline or new
- Determine comfort level
- Explain actions and treatments
- When transporting, bring all aids required by patient
Abuse and Neglect
Vulnerable Population
- Patients dependent on others
- More vulnerable to physical and sexual abuse, exploitation, neglect
- May be children or adults
- Elderly especially vulnerable
Abuse and Neglect
What to Look For
- Stories that are inconsistent with injuries
- Multiple injuries in various stages of healing
- Repeated injuries
- Caregivers’ indifference to patient
Abuse and Neglect
What to Do
• Do not make accusations
• Do best to get patient out of environment
• Report suspicions according to
requirements of jurisdiction
Chapter Review: Special
• Patients with special challenges include those who are homeless or living in poverty, are very obese, have sensory impairments, are terminally ill, have developmental disorders, and who are technology-dependent.
Chapter Review: Special
- A disability is a condition that interferes with a person’s ability to engage in everyday activities, such as working or caring for oneself.
- The homeless, poor, and obese are at increased risk for health problems.
Chapter Review: Special
- Do not assume that a particular patient with special challenges requires EMS for problems related to the disability or chronic condition.
- Treat patients with special challenges with empathy and respect.
Chapter Review: Special
• When dealing with patients who have autism, use ABCS: Awareness, Basic, Calm, and Safety.
• Patients, their families, and their
caregivers are often very knowledgeable about patient needs and special equipment. Rely on their expertise and
involve them in care.
Remember: Special
• Assistive equipment and special
accommodations allow many with special challenges to live normal lives.
• Beware of overstimulating a patient with an autism spectrum disorder.
Remember: Special
• To ensure proper care, you must recognize, understand, and evaluate the patient’s special health care challenges in
addition to the presenting problem or chief complaint that led to the call to EMS.
Remember: Special
Remember
• Caregivers and patients can provide valuable information on special health challenges and advanced medical devices.
• A chronic disease or medical condition may present as a primary problem or may complicate another illness or injury.
Remember: Special
• When encountering an advanced medical device, consider what the device is doing
for the patient and how important the device is to the patient’s survival.
• Special health challenges often make patients more vulnerable to abuse and neglect.
