Transcript 011509 No pics Special Patient Populatio

Special Patient
Populations
Chemeketa Community College
Paramedic Program
P. Andrews, Instructor
W 09
Objectives; Manage
Patients with:
 Hearing
impairments
 Visual impairments
 Speech
impairments
 Obesity
 Paraplegia/quadripl
egia
 Mental illness
 Developmentally
disabled
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Down syndrome
Arthritis
Cancer
Cerebral palsy
Cystic fibrosis
Multiple sclerosis
Muscular dystrophy
Myasthenia gravis
Poliomyelitis
Spina bifida
Previous head injury
Objectives, cont.
 Culturally diverse
 Terminally ill
 Communicable
disease
 Financial
impairment
Hearing Impairments
 Types;
 Conductive
 Otitis media
 Impacted earwax
 Water
 Hematomas
 Sensorineural
 Congenital defects or birth injuries
 Rubella
 Labyrinthitis
 Tumors
 Repeated loud noises
 Progressive deafness assoc. with aging
 Nearly 80% is related to hghpitched sounds.
Tricks that work
 Face the patient
 Speak clearly, at a normal rate
 Identify yourself
 Speak in lower tones
 Try to limit background noise
 Try to find the patient’s hearing
aids; if not…. Place stethoscope in
patients ears and speak into
diaphragm
 Use ASL interpreter, prn
Visual Impairments
 Injury
 Enucleation
 Chemical, thermal burns
 Disease
 Glaucoma
 Diabetic retinopathy
 Congential, degenerative disorders
Tricks that work
 Identify yourself as you approach
 Describe everything as you do it
 Do NOT pet a service dog
 You need to transport the dog also
Speech Impairments
 Language disorders
 Cerebral palsy
 Hearing impairments
 Stroke
 Brain tumor
 Hearing loss
Speech impairments, cont.
 Aphasia
 Sensory
 Can’t understand spoken word
 Motor (Expressive)
 Can’t make words or speak wrong words
 Global
 Both sensory and motor
 Brain tumor in Broca’s region
Speech impairment, cont.
 Dysarthria
 Sounds are put together incorrectly
 Neural damage
 Slurred speech
 Voice production disorders
 Hoarseness, harshness, loss of voice
 Fluency disorders
 stuttering
Tricks that work
 Never assume they are not
intelligent
 Don’t rush patient, interrupt or
complete their sentences
 Try to ask questions that require
short answers
 Look directly at patient when
asking questions.
obesity
 > 40% in US
 20-30% heavier than normal
 Provide thorough exam and obtain
thorough history
 Make accomodations for their
weight
 Ecg
 Lung sounds
Obesity, cont.
 Bariatric ambulance, gurney
 Get enough help
 YOUR safety first
Paralysis
 May be paraplegic or quadriplegic
 Cord injuries at C3 – C5 may
paralyze respiratory muscles and
compromise breathing – ventilator?
 Often from a previous injury – not
the reason you’re there today
 If pt is on a vent., airway is priority
 Keep suction handy
 May need BVM
 Reassure patient
 If paralysis is recent, a halo may be
present;
 Stabilize before transport
 Paralyzed patients often have a
colostomy bag
 Take any other assisting devices;
 Wheelchairs, canes
Mental Challenges &
Emotional Impairments
A special challenge to us.
 Schizophrenia
 Personality disorders
 Psych conditions 2nd to emotional or
physical trauma
How will YOU cope?
Developmental disabilities
 Pt. can’t learn at usual rate
 Genetic
 Brain injury caused by hypoxic or
traumatic event
 May be difficult to recognize
 Treat pt as you would any other
 They recognize body language, tone,
etc just like anyone else
Tricks that work
 This group of pt has higher than
average risk of abuse
 Make it clear that you are part of
EMS (pt’s are often taught ‘stranger
danger’)
 Reassure pt. – they are often
frightened by equipment, vehicles,
noise, etc.
 Keep primary caregiver with you at
all times
 Use terms they will understand
 Demonstrate techniques on you or
your partner
Down Syndrome
 Common physical characteristics
 Eyes slope up
 Folds of skin on either side of nose,
covers inner corner of eye
 Small face and features
 Large, protruding tongue
 Flattening of back of head
 Short, broad hands
Down syndrome, cont.
 Common physical ailments
 Heart defects
 Intestinal defects
 Chronic lung problems
 Higher risk of cataracts, blindness,
early onset Alzheimer’s
Fetal Alcohol Syndrome
 A preventable disorder
 Characteristic features;
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Small head with multiple facial deformities
Small eyes with short slits
Wide, flat nose bridge
Lack of a groove between nose and lip
Small jaw
Delayed physical growth
Mental disabilities
hyperactivity
Arthritis
 Juvenile rheumatoid arthritis
 Connective tissue disorder
 Sx before age 16
 Rheumatoid arthritis
 Autoimmune disorder
 Osteoarthritis
 Degenerative joint disease
 Most common arthritis in elders
Arthritis, cont.
 Symptoms;
 Painful swelling and irritation of joints
 Joint stiffness and limited ROM
common
 Smaller joints of feet and hands
become deformed.
 JRA pt’s; spleen or liver
complications
Tricks that work
 Pay attention to their meds; you
may be there to treat s/s of med
effects
 NSAIDs
 Corticosteroids
 Transport;
 Move gently
 Pad joints with pillows
Cancer
 Patients have greatly increased risk
of infection
 Rapid onset of sepsis
 Difficult IV start
 Involve patient in decision-making
as much as possible
Cerebral Palsy
 A group of disorders caused by
damage to cerebrum in utero or
during birth
 Premature birth
 Difficult delivery
 Exposure to German Measles
 encephalitis
 Meningitis
 Head injury
CP, cont.
 Spastic muscles
 Affects a single limb or entire body
 2/3 CP pts have below normal
intellectual capacity
 ½ have seizures
 3 main types
 Spastic paralysis
 Athetosis
 Ataxia
CP, cont.
 Spastic paralysis (most common)
 Muscles in state of permanent stiffness
and contracture
 Athetosis
 Involuntary writhing movement;
usually extremities
 May demonstrate drooling, grimacing
CP, cont.
 Ataxic cerebral palsy (least
common)
 Problems with coordination of gait
and balance
Tricks that work
 Don’t assume you can’t
communicate – some CP pts are
highly intelligent
 Use pillows and blankets to pad
extremities
 Have suction available
Cystic Fibrosis
 Inherited disorder; involves
exocrine glands in lungs &
digestive system
 Bronchoconstriction
 Atelectasis
 Blockages in small ducts of pancreas
CF, cont.
 Common PMH:
 Frequent lung infections
 Clay colored stool
 Clubbing of fingers and toes
 Most CF pts are children and
adolescents – life expectancy to
30’s
Tricks that work
 Although chronically ill, still
pediatric patients – treat children as
children
 Provide oxygen and suction
 Take all medications along
Multiple Sclerosis
 CNS disorder; most between 20 –
40 y/o
 Autoimmune disorders
 Repeated inflammation = scar tissue =
blocked impulses to area
 Slow onset
Tricks that work
 Help pt to position limbs for
comfort.
 Don’t expect pt to walk
 Bring wheelchair or other devices
along
Muscular Dystrophy
 Genetic disorder, leading to gradual
degeneration of muscle fiber
 Duchene MD most common form
 Affects boys between 3 – 6 y/o
 Eventually affects respiratory muscles
and heart
Poliomyelitis
 A communicable disease
 Affects gray matter and spinal cord
 Enters body through GI tract
 Uncommon in developed countries
Previous head injuries
 May display s/s similar to stroke
(without hemiparesis)
 Slurred speech
 Visual or hearing changes
 Short-term memory loss
 PMH important
Spina Bifida
 Congenital abnormality
 Defect in closure of backbone and
spinal cord
 Spina bifida occulta (few s/s)
 Spina bifida cystica (spinal cord
protrudes from back)
Spina bifida, cont.
 A large percentage have
hydrocephalus
 Up to 73% have latex allergies
 Take along any assistive devices
Myasthenia Gravis
 Autoimmune disease
 Chronic weakness of voluntary
muscles, progressive fatigue
 Occurs most frequently in women, 20
– 50 y/o
Myasthenia gravis, cont.
 Common c/c;
 Complete lack of energy esp. in
evening
 Facial muscles most commonly
effected; eyelid drooping or difficulty
chewing or swallowing
 Double vision
 Respiratory muscles may be affected.
Tricks that work
 If respiratory distress in noted,
assist ventilation enroute to hospital
Culturally diverse
patients
 Ethically required to treat without
regard for ethnic background –
 How do you provide treatment
AND respect the patient’s diversity?
Summary
 Compassion and a basic respect for
humans will get you through most
any call!