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TRANSITION SERIES TRANSITION SERIES Topics for the Advanced Topics for the Advanced EMT EMT CHAPTER Special Challenges Special Challenges 47

TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

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Page 1: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

TRANSITION SERIESTRANSITION SERIES

Topics for the Advanced EMTTopics for the Advanced EMT

CHAPTERCHAPTER

Special ChallengesSpecial Challenges

4747

Page 2: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

ObjectivesObjectives

• Discuss basic descriptions of the size of the problem regarding special challenge cases.

• Discuss pathophysiology of unique emergencies that may be seen by EMS.

Page 3: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

Objectives (cont’d)Objectives (cont’d)

• Discuss a general assessment approach and treatment strategies for these patients categorized as “special challenges.”

Page 4: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

IntroductionIntroduction

• Due to lifestyle changes and medicine, the life spans of humans are lengthening.

• Advances in medicine allow technology to go home with the patient.

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Introduction (cont’d)Introduction (cont’d)

• Congenital disease patients live longer at home, due to medicine.

• EMS may not know what the medical technology is, but they must always know what to do.

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EpidemiologyEpidemiology

• No specific registry or definition for what “specially challenged” is.

• Underreporting is also believed to occur, especially with abuse.

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Epidemiology (cont’d)Epidemiology (cont’d)

• Over 3 million pediatric abuse cases and over half a million elder abuse cases.

• 8 million disabled people are receiving health care from professional providers.

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PathophysiologyPathophysiology

• Abuse– Child abuse

Physical, emotional, sexual

– Elder abuse Physical, emotional, sexual

– Passive versus active Neglect

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Physical abuse of an elderly person can have dire consequences because of the patient’s frailty.

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Pathophysiology (cont’d)Pathophysiology (cont’d)

• Mental Illness– Mild to severe disabilities– Commonly include the following

features: Cognitive disabilities Speech impediments Behavioral disorders Movement disorders

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Causes of Mental Retardation

Page 12: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

Causes of Mental Retardation

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Pathophysiology (cont’d)Pathophysiology (cont’d)

• Disabilities– A problem of the patient that was

caused by a disease, that results in sustained medical care for the person.

– Common disabilities seen in EMS include: Paralysis Obesity Traumatized patients

Page 14: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Disabilities – Paralysis– Loss of function of single or multiple

muscles– Damage to nervous system (spinal cord)– Neuromuscular diseases

Page 15: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Disabilities – Obesity– Over 40% of the U.S. population is

obese.– Obesity may be due to lifestyle choices

or medical conditions.– Obesity creates a multitude of

secondary emergencies.– Obesity also creates a patient handling

and movement concern for EMS.

Page 16: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

Effects of Excess Weight on Organ Systems

Page 17: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Disabilities—Traumatized patients– Head and/or brain trauma– Commonly there are residual effects

Mild—speech or gait impairments Severe—unresponsive, seizures,

technology dependent

– Most patients fall between these two extremes.

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Pathophysiology (cont’d)Pathophysiology (cont’d)

• Technology Assistance/Dependency– Medical equipment designed for patient

care Enhances quality of life Sustains life

– EMS must remain aware of common types of equipment.

– Some EMS systems track where patients live who are technology dependent.

Page 19: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Apnea Monitor– Monitors patient's breathing status– Some monitor heart rate– Common to neonates and infants– Audible alert for when patient stops

breathing

Page 20: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Tracheostomy Tube– Provides an artificial opening into the

airway.– Placed through the anterior of the neck.– Bypasses the mouth and nose.

Page 21: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

A tracheostomy tube for older children and adults has an outer cannula and an inner cannula.

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The AEMT can ventilate a patient with a tracheostomy by attaching the bag-valve device to the tracheostomy tube’s 15/22 mm adapter.

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Pathophysiology (cont’d)Pathophysiology (cont’d)

• CPAP and BiPAP– Designed to provide “back pressure” via

mask that attaches to face.– Helps to keep small bronchioles open

during breathing, and the airway open during sleep.

– Commonly found with obese patients and certain chronic lung diseases.

Page 24: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Home Mechanical Ventilators– Assist or provide total ventilatory needs

to a patient who cannot maintain own ventilatory effort.

– Include negative and positive pressure units.

– Controls include rate, volume, and occasionally oxygen levels.

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Pathophysiology (cont’d)Pathophysiology (cont’d)

• Home Mechanical Ventilators– Alarms (may be reason EMS is

summoned) High pressure alarm Low pressure alarm Apnea alarm Low FiO2 alarm

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Vascular access devices include central IV catheters such as a PICC line, central venous lines such as the Broviac catheter, and implants ports such as the MediPort system.

Page 27: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Vascular Access Devices– Devices implanted into the skin.– Allow for ongoing or multiple medication

administrations into the patient's vascular system.

• Dialysis– Replaces kidney function.– Hemodialysis—done at facility.– Peritoneal dialysis—done at home.

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Pathophysiology (cont’d)Pathophysiology (cont’d)

• Feeding Tubes– Provide nutrition to patients who cannot

chew.– “Enteral feeding” or “tube feeding”– Types

NG tube—nose to stomach OG tube—mouth to stomach G-tube—through skin to stomach J-tube—through skin to jejunum (middle

section of the small intestine)

Page 29: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Intraventricular Shunts– Medical illnesses or anatomic defects

that allow excessive CSF to accumulate.– Increased CSF can cause damaging ICP

issues.

Page 30: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Intraventricular Shunts– Shunt is placed in ventricle of brain and

extends to blood vessel in neck, heart, or abdomen.

– Occasionally there may be an external reservoir.

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Assessment FindingsAssessment Findings

• During your assessment, ask about the medical equipment.– Where do I get the best information

regarding this equipment?– What does this device do for the

patient?– Can I replicate its function should it fail?– Will this equipment change assessment

findings?

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Assessment Findings (cont’d)Assessment Findings (cont’d)

• During your assessment, ask about the medical equipment– Has this ever occurred before? What

fixed it?– Has anyone attempted to remedy the

problem?– Do I have movement or handling issues

with this equipment?

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Emergency Medical CareEmergency Medical Care

• Manual cervical spine considerations• Assess and maintain the airway.• Determine breathing adequacy.

– High-flow via NRB with adequate breathing.

– High-flow via PPV @ 10-12/min if inadequate.

– Maintain saturation >95%.

Page 34: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

Emergency Medical Care (cont’d)Emergency Medical Care (cont’d)

• Assess circulatory components.– Check pulse, skin characteristics.

Page 35: TRANSITION SERIES Topics for the Advanced EMT CHAPTER Special Challenges 47

Emergency Medical Care (cont’d)Emergency Medical Care (cont’d)

• Initiate transport with Paramedic intercept.

• Position the patient based on condition and medical equipment.– Consider immobilization needs.

• Constantly monitor airway, breathing, and circulation.

• Try to use medical equipment if it is portable and working correctly.

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SummarySummary

• Patients with special needs are those who usually have some medical technology helping them with life.

• When this equipment malfunctions, typically it is EMS that is called.

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Summary (cont’d)Summary (cont’d)

• The role of the Advanced EMT is to manage the patient's problem(s), incorporating this technology into their assessment and management.