Download AEMT Transition - Unit 47

TRANSITION SERIES
Topics for the Advanced EMT
CHAPTER
47
Special Challenges
Objectives
• Discuss basic descriptions of the size of
the problem regarding special challenge
cases.
• Discuss pathophysiology of unique
emergencies that may be seen by EMS.
Objectives (cont’d)
• Discuss a general assessment approach
and treatment strategies for these
patients categorized as “special
challenges.”
Introduction
• Due to lifestyle changes and medicine,
the life spans of humans are
lengthening.
• Advances in medicine allow technology
to go home with the patient.
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.
Epidemiology
• No specific registry or definition for
what “specially challenged” is.
• Underreporting is also believed to
occur, especially with abuse.
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.
Pathophysiology
• Abuse
– Child abuse
 Physical, emotional, sexual
– Elder abuse
 Physical, emotional, sexual
– Passive versus active
 Neglect
Physical abuse of an elderly person can have dire consequences because of
the patient’s frailty.
Pathophysiology (cont’d)
• Mental Illness
– Mild to severe disabilities
– Commonly include the following
features:
 Cognitive disabilities
 Speech impediments
 Behavioral disorders
 Movement disorders
Causes of Mental Retardation
Causes of Mental Retardation
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
Pathophysiology (cont’d)
• Disabilities – Paralysis
– Loss of function of single or multiple
muscles
– Damage to nervous system (spinal
cord)
– Neuromuscular diseases
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.
Effects of Excess Weight on Organ Systems
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.
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.
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
Pathophysiology (cont’d)
• Tracheostomy Tube
– Provides an artificial opening into the
airway.
– Placed through the anterior of the neck.
– Bypasses the mouth and nose.
A tracheostomy tube for older children and adults has an outer cannula and
an inner cannula.
The AEMT can ventilate a patient with a tracheostomy by attaching the bagvalve device to the tracheostomy tube’s 15/22 mm adapter.
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.
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.
Pathophysiology (cont’d)
• Home Mechanical Ventilators
– Alarms (may be reason EMS is
summoned)
 High pressure alarm
 Low pressure alarm
 Apnea alarm
 Low FiO2 alarm
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.
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.
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)
Pathophysiology (cont’d)
• Intraventricular Shunts
– Medical illnesses or anatomic defects
that allow excessive CSF to accumulate.
– Increased CSF can cause damaging ICP
issues.
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.
Assessment 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?
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?
Emergency 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%.
Emergency Medical Care (cont’d)
• Assess circulatory components.
– Check pulse, skin characteristics.
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.
Summary
• 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.
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.