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Chapter 32
Patients with Special Needs
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Patients with
Special Needs
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Patients with Special Needs
EMTs are discovering that a
number of people in their
communities have advanced
medical devices in their homes.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Advanced Medical Devices
in the Home
Patients who previously may have
been unable to survive at home are
now afforded the opportunity and
relative comfort of living and
working in a normal, non-hospital
environment.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Knowledgeable Care Givers
Medically trained, such as an:
– RN, CNA, or home health aide
More often it will be a family
member or friend.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Diseases and Conditions
Congenital disease
– Condition is one that is present at birth
or may be genetic
Acquired disease
– Occurs after birth and may be the
result of exposure to a virus or
bacteria
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Advanced Medical Devices
Respiratory devices
Cardiac devices
Gastrourinary devices
Central IV catheters
Physical impairments
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Respiratory
Devices
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Continuous Positive Airway
Pressure Devices (CPAPs)
Machine that
provides constant
pressure, through
a tube and mask,
to prevent airway
passages from
collapsing at the
end of a breath
© Don Garbera/Phototake USA
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Continuous Positive Airway
Pressure Devices (CPAPs)
CPAP helps the following diseases:
– Pulmonary edema
– Asthma
– COPD
© AP Photo/The Herald, Julie Busch
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Tracheostomy Tubes
Surgical opening in the neck into the
trachea
When the opening created is
permanent, it is called a stoma.
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Tracheostomy Tubes
Assessment and Transport
Carefully assess the tracheostomy
tube for any blockage, and clear it
(under protocol, or by having care
givers perform the task).
If the patient is on a ventilator, he
may need to be ventilated by a BVM
between suctioning.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Home Ventilators
A ventilator is a device that breathes
for a patient.
It is programmed to take over the
functions of inhalation, exhalation,
timing, and rate of breathing.
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Home Ventilators
Assessment and Transport
While caring for a patient with a
home ventilator, ensure that the
ventilator tube does not have any
mucus buildup, suctioning as
needed.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Cardiac Devices
Implanted Pacemakers
The pacemaker is designed to
prevent the heart rate from
becoming too slow.
Early pacemakers were set at a
fixed rate, but modern pacemakers
are “rate-responsive”; that is, they
detect what the patient is doing and
modify the heart rate accordingly.
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Cardiac Devices
Automatic Implanted Cardiac
Defibrillator (AICD)
Like a pacemaker, an AICD is placed
under the skin with wires inserted into
the heart.
The implanted defibrillator is designed
to detect life-threatening cardiac
rhythms (ventricular fibrillation and
ventricular tachycardia).
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Cardiac Devices
Assessment and Transport
Depending on the nature of the call
and chief complaint, the EMT may
wish to have ALS transport for a
patient with a pacemaker or AICD
device.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Left Ventricular Assist Devices
(LVADs)
A recent advance in cardiac care is the
left ventricular assist device (LVAD).
The LVAD moves blood from the left
ventricle through an inserted tube to a
pump implanted in the abdomen where
the blood is pressurized and sent to
the aorta for transport to the body.
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Left Ventricular Assist Devices
(LVADs)
Assessment and Transport
Transport: The patient with an LVAD will
have an external battery pack that may
be the size of a small backpack or
briefcase.
Failures of the battery system should
first be addressed by attempting to plug
the unit into an AC source in the home,
inverter in an ambulance, or other.
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Left Ventricular Assist Devices
(LVADs)
© AP Photo/George Widman
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Gastrourinary
Devices
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Feeding Tube
A feeding tube is used in a patient
who is unable to feed himself or
can’t swallow.
A feeding tube is most commonly
seen in one of two forms: a
nasogastric tube or a gastric tube.
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Feeding Tube
© AP Photo/The Charlotte Observer, David T. Foster III
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Feeding Tube
Assessment and Transport
Ensure that the feeding tube is
secured with tape to the patient’s
body before transport.
If protocols allow, and nutrients are
being administered during transport,
keep the nutrient source higher than
the level of the NG tube or G-tube.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Urinary Catheters
A urinary catheter is used for a
patient who has lost the ability to
urinate or has the lost the ability to
regulate when he urinates.
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Urinary Catheters
© Phototake USA/Yoav Levy
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Urinary Catheters
Assessment and Transport
During transport, keep the catheter
bag lower than the level of the
patient but not on the floor.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Ostomy Bags
An ostomy bag is connected to a
colostomy or an ileostomy, which is
a stoma in the abdomen that has
external tubing to allow fecal
drainage from the colon or ileum.
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Ostomy Bags
Assessment and Transport
Use care when moving a patient if an
ostomy bag is present to prevent
breakage or dislodgement through
rough handling.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Dialysis
The kidneys are unable to remove
the buildup of toxins that occurs
with the metabolism of daily life.
Dialysis removes these toxins and
filters the blood, taking over some
of the roles the kidneys play in
detoxifying the blood.
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Dialysis
Dialysis serves two important roles:
– Waste removal
– Fluid removal
There are two forms of dialysis:
– Hemodialysis
– Peritoneal dialysis
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Dialysis
Assessment and Transport
Do not take a blood pressure on any
arm with an AV shunt, fistula, or
graft—it could cause damage that
would require surgical repair.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Central IV Catheters
Central IV catheters are inserted
during surgery or under
radiography. They prevent
patients from having to endure
multiple needlesticks.
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Central IV Catheters
Peripherally inserted central
catheter (PICC) line
– Has an external tube slightly larger
than IV tubing, which is inserted into a
peripheral vein from which it is
threaded into the central circulation
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Central IV Catheters
Central venous line
– May be inserted through a subclavian,
jugular, or femoral vein. Central
venous lines carry a variety of brand
names, such as a Groshong®, a
Hickman®, or a Broviac® catheter.
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Central IV Catheters
Implanted port
– This port has no external tubing.
Special needles are required to
access these ports. Brand names
include Port-a-Cath® and Mediport®.
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Central IV Catheters
Assessment and Transport
In most cases, neither the EMT nor a
family caregiver will use a central IV
catheter to administer medications to
the patient or for any other purpose.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Physical Impairments
Impairments that affect hearing,
sight, or speech
Each limitation requires different
approaches and considerations
when you are assessing and
treating the patient.
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Physical Impairments
Assessment and Transport
Approach and treat each patient with
one or more physical impairments by
providing whatever extra assistance
they require.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Review Questions
1. List several advanced medical devices
you might find when responding to
patients with special needs at home.
2. Differentiate congenital diseases from
acquired diseases or conditions.
3. If a tracheostomy tube is blocked and
your protocols allow, describe a
method of clearing the blockage.
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Review Questions
4.
If a ventilator that a patient relies on to
breathe malfunctions, what life support
care should you perform?
5.
If a patient’s pacemaker or AICD
malfunctions, in addition to transport to
the hospital, what care should you
provide?
6.
If a patient cannot hear or cannot speak,
describe several methods that might
facilitate communication with him.
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Street Scenes
What is this patient’s priority?
What additional information do you
need to treat the patient?
(cont.)
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Street Scenes
How should you reassess the
patient?
What equipment should you take to
the hospital with Amber?
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Sample Documentation
Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ